Workplace BUG (Bicycle User Group) Registration Form

1. Register your workplace BUG

 
Add your Bicycle User Group (BUG) to the growing list of workplace BUGs by completing the following brief registration form.

By making yourself known to Bicycle Network, we can stay in contact with you and make resources available to you.

If you permit us to do so, we will publish your email address on our growing online list of BUGs so that other BUGs and workplace members can make contact with you.

Registration form length: 11 questions
Time to complete: 2-5 minutes

Protecting your privacy
We collect, use, disclose and otherwise handle your personal information in accordance with the terms of Bicycle Network's Privacy Policy Statement. See www.bicyclenetwork.com.au (Search: privacy) for full details. All information remains the property of Bicycle Network. We do not collect personally identifiable information about you except when you specifically provide this information on a voluntary basis. We will make every effort to ensure that whatever information you provide will be maintained in a secure environment.
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1. What is the name of your BUG?
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2. What is the name of your workplace?
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3. What is your workplace street address?
4. What is your workplace postal address (if different from above)?
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5. What is your name?
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6. What is your work phone number?
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7. What is your work email address?
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8. How many people are employed in your workplace? (please estimate)
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9. How many people do you estimate will join your BUG in the next twelve months?
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10. Has your BUG planned any activities since forming (e.g. breakfast, meeting, workshop)?

If so, please list.
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11. Would you like Bicycle Network to add your BUG's contact details to our growing list of Australian Workplace BUGs on our website?

Protecting your privacy
We collect, use, disclose and otherwise handle your personal information in accordance with the terms of ourPrivacy Policy Statement. See www.bicyclenetwork.com.au (search term: privacy) for full details. All information remains the property of Bicycle Network.
We do not collect personally identifiable information about you except when you specifically provide this information on a voluntary basis. We will make every effort to ensure that whatever information you provide will bemaintained in a secure environment.

If you have any additional comments/questions about this survey, please feel free to contact us:

Bicycle Network
Level 4, 246 Bourke Street, Melbourne Vic 3000
Ph 03 8376 8888 Fax 03 8376 8800
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