First Name:

Last Name:

E-Mail:

Phone:

Street:

City:

State or province:

Zip:

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Email

Fundraising goal ($1000 minimum): Have you raised this much money for an event before?
Yes
No

If not, would you like tips as to how to fundraise?
Yes
No

Do you understand that if there is any left over money from your $250 registration, that this amount will be given to Africycle?
Yes
No

Are you able to attend the mandatory information meeting on Sunday, May 16th at 2:00 PM, located at 280 Perry St. Unit #8, Peterborough, ON?
Yes
No

Are you able to be in Peterborough on the Thursday night, July 1st, before we leave?
Yes
No

Would you have arranged accomodation?
Yes
No

If not, would you like us to arrange free accomodation for you?
Yes
No

Would you be interested in attending a mandatory bicycle safety course the night before we leave?
Yes
No

Are you vegetarian or vegan?
Yes
No

Are you lactose intolerant?
Yes
No

Do you have any other dietary restrictions/concerns?

Do you have the necessary documents to travel to the U.S.?
Yes
No

If not, will you arrange that?
Yes
No

Do you have travel insurance arranged?
Yes
No

If not, will you arrange that?
Yes
No

Type, Make, Model and Year of bicycle you intend to ride:

Are you able to change a flat tire on your bicycle?
Yes
No

Are you able to tune your bicycle?
Yes
No

How would you describe your attitude in general as a cyclist and as a person?

Do you understand that if you have an attitude that is detrimental to the team, that you will be asked to go home? (Please understand that this has never happened and we have always had wonderful people ride with us so far)
Yes

Do you understand that you are required to pay $250 to complete your registration (Payment options will be given once you click 'submit')?
Yes

(Only click the Submit Button Once)