» Registration Form
Title
e.g. Mr, Mrs etc..
First Name *
Last Name *
Email *
Telephone/Mobile*
Age
0-16
17-20
21-30
31-40
41-50
51-60
60+
Sex
Male
Female
Interested in
Appointments
Bike Mechanic
Loan Bike
LifeCycle
Accompanied ride
Route planning
Participation Code
No Access (NA)
Not Home (NH)
Not interested (NI)
Phone Back (PB)
Call Back (CB)
Participant level 1 (P1)
Participant level 2 (P2)
Participant level 3 (P3)
Cycling City Awareness Code
Not aware (A0)
Knows a bit (A1)
Knows a lot (A2)
Cycling Code
Non-cyclist -due age/infirm (NCA)
Non Cyclist / Cyclist - less than 1x month (C1)
Cyclist - 1 x month or more (C2)
Cyclist - 1 x week (C3)
Cyclist - more than 1 x week (C4)
Cyclist - daily (C5)
Uses bike for leisure, shopping
Uses bike to commute
Don't know
Contact through:
Door knocking
Workplace event
Public event
Word of mouth
Website
Other
Employer
Workplace advice programme only
Place Of Work
Workplace advice programme only
Address*
Flat No:
Building Name:
House No:
Street:
Area:
City:
Postcode:
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Comments
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