JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Peloton Rider Application
Please complete the form to apply for the 2016 Wellspring Peloton Challenge.
If you have any questions, please contact Susan Chung at
susan@wellspring.ca
or call 416-961-1928 ext. 238.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Last Name
*
Your answer
Given Names
*
Your answer
Address Line 1
*
Your answer
Address Line 2
Your answer
City and Province
*
Your answer
Cell Phone Number
*
Your answer
Home phone number
Your answer
Email Address
*
Your answer
Principal Occupation
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Sex
*
Male
Female
How did you hear about the Wellspring Ride for Cancer Support, Peloton Challenge? (select all that apply):
*
Family/Friend
Website or AD
Poster or Brochure
Wellspring Literature
Other:
Why are you interested in becoming a rider for the 2016 Wellspring Ride for Cancer Support, Peloton Challenge?
*
Your answer
Endurance Events
Please describe your comfort level with endurance events
*
Not at all comfortable
1
2
3
4
5
Extremely comfortable
Please describe your experience with endurance cycling:
*
Your answer
Cycling Experience
Please rate your comfort level with cycling:
*
Not at all comfortable
1
2
3
4
5
Extremely comfortable
Please describe your cycling background:
*
Your answer
How many kilometers a year do you cycle?
*
Your answer
What is the longest distance you have cycled in a single day?
*
Your answer
Fundraising
Please describe your comfort level with fundraising:
*
Not at all comfortable
1
2
3
4
5
Extremely comfortable
Next
Page 1 of 3
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
