Action Network

Ride Durham - 11/22

Not in the US?

What is the birth year of the individual signing up? *

How does the participant identify their gender?

What is your race and/or ethnicity?

Emergency Contact Information *

Are you or participant able to comfortably ride a bike with pedals, use your brakes, and steer? * Yes Not yet (Please sign up for Ready to Ride)

Does participant have a bike in good working condition for this class? * Yes No

Do you (or participant) have a Bike Helmet? * Yes No

If you (or participant) needs a bike for the class, please specify your height *

Please share any physical needs, mobility limitations, or accommodations that would help us support you (or participant) during class. *

How did you hear about this class? *

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Sponsored by: Bike Durham