Adult Bicycle Maintenance 101 Form

Participant Info

Participant Name(Required)

First Last

Participant Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Birthday(Required)

Youth Info

Are you signing up a child between the ages of 14 and 17 for this? If you answer yes, please fill out the following section:(Required)

Youth Name

First Last

Youth Birthday

Contact Info

Cell Phone Number(Required)

Email(Required)

Are there specific issues with your bicycle that you'd like to learn more about?

Which class are you signing up for?(Required)

Discount Eligibility Information

This section will be used to determine if a discounted rate will be applied to your registration if you are interested in being considered for a discounted rate.

What is the gross household income? (Gross income is your salary and earnings before taxes) | If you can only answer for one of the boxes please answer N/A in the other box.

Annual Monthly

How many people are in this household that are supported by this income?

Emergency Contact Information

Name:(Required)

First Last

Phone:(Required)

Relationship:(Required)