| ABOUT YOU | |
| First Name: |
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| Middle Name: |
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| Last Name: |
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| Address 1: |
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| Address 2: |
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| City, State: |
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| Zip: |
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| Phone: |
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| Work Phone: |
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| Cell Phone: |
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| E-mail: |
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| FOR RESEARCH PURPOSES ONLY |
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| Sex: |
Male
Female |
| Age: |
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| Number of persons in household: |
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| Total annual household income before taxes: |
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| Highest level of education: |
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| How did you first learn about us? |
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| If other, please explain: |
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| Ethnic background: |
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| Other ethnicity: |
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| YOUR CYCLING HABITS |
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How do you use your bike?
(check all that apply) |
Recreation (visiting a park, riding trails)
Social (visiting a friend, going to an event)
Fitness
Commuting to work
Commuting to school
Running errands
Other:
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Where do you ride most often?
(check all that apply) |
Unmarked streets
Marked bike lanes
On paved/crushed stone trails
Mountain bike trails
Other:
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| What trail do you ride most often? |
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| YOUR VOLUNTEER INTERESTS |
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| COMMUNICATION PREFERENCES |
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Please send my Bike Traffic newsletter subscription to me electronically via mail
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Please send me "Bike Bulletin" e-mail notices about bicycling issues in the region
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Please include my name in mailing lists to other groups promoting events or offering products related to bicycling
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Please contact me about being a liaison to the following bicycling group(s) that I belong:
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| FRIENDS AND FAMILY |
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| We rely on our members to steer us in the direction of potential new members. If you have friends, family members and work colleagues who like to bike and might be interested in membership, please let us know and we will send them a membership packet:
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| Name/Organization: |
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| Address: |
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| Relationship (i.e. friend, relative): |
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| Name/Organization: |
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