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* 1. Contact Information

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* 2. Gender

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* 3. Height (not necessary to answer this for TS 101 course)

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* 4. Do you have a bicycle?

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* 5. What is the approximate longest distance in miles you have ridden in one day during the past year? (TS 101 Students only)

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* 6. Which course are you interested in taking?

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* 7. Check the kind of riding you do or would like to do.

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* 8. What do you hope to gain from this course?

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* 9. (FOR SUMMER LTR STUDENTS ONLY) Do you have any physical or emotional conditions that you feel might limit your participation in this course? Even if you have a mild fear of falling, please let us know. Offer as much detail as possible, or write "none."

All students should bring a notebook and something to write with. Also, bring something to drink and a small snack. The class will include two 15-minute breaks. We ask students to please bring their bike helmets for learning how to properly adjust them.

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* 12. Release: (Note: Helmets are required for all LTR and TS 101 on-bike participants.) I am aware of the risk of bicycling and otherwise participating in this course and voluntarily assume such risk. In consideration of being permitted to participate in this event: (1) I release for myself, my heirs, and personal representatives, the League of American Bicyclists, Inc., and the respective directors, officers, volunteers, and staff (releasees) from any claim liability, demand, action, and cause of action whatsoever (collectively, "Claim") arising out of or related to any loss, damage or injury (collectively, "Loss"), to myself or my property, that I may sustain in connection with, or arising out of, this event, whether caused by the negligence of the releasees or otherwise; (2) If registrant is a minor, I (as parent or guardian) agree to indemnify and hold harmless each releasee against any claim for any Loss said minor may sustain in connection with or arising out of, this event, and against legal or other expenses incurred by any releasee in connection with defending any Claim by or on behalf of said minor for any such loss, whether caused by the negligence of the releasees or otherwise; (3) I shall obey traffic laws and practice safety in bicycling; and (4) I agree to wear a CPSC or ASNI/SNEL-approved helmet on all bicycle-riding activities at this event.
Enter your name and today's date in the box below as your electronic signature.

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