Bike to Work - Bike Shop Registration 2011

1. Bike to Work - Bike Shop Signup

Question Title

* 1. Business Name:

Question Title

* 2. Address:

Question Title

* 3. Hours of Operation:

Question Title

* 4. Phone:

Question Title

* 5. Fax:

Question Title

* 6. Contact Person:

Question Title

* 7. E-mail:

Confirming the agreement below indiciates a commitment to be a Participating Bike Shop for Northern Nevada Bike to Work Week. Participating Bike Shops will be listed on the event website.

Question Title

* 8. This commitment includes:

I would like to be a Participating Bike Shop:

My shop will hang posters and provide postcards to customers.

My shop will provide free bike "Safety Assessment" to anyone that mentions Bike to Work Week 2011. A Safety Assessment includes a bike inspection to determine use-ability and safety, but does not include actual remedy and/or repair of the bicycle. This will also include a helmet fitting.

My shop will provide safety clinics on topics related to commuting safety and bicycle maintenance & repair. Topics, times, and locations will be provided to the Bike to Work Committee by April 15th 2011.

My shop will become a Bike to Work Week 2011 sponsor.

Question Title

* 9. Name of Person Completing Form:

Question Title

* 10. I am authorized to make this commitment on behalf of this business.

Yes

Question Title

* 11. Why are you participating in Bike to Work Week 2011?

Question Title

* 12. Other comments:

Question Title

* 1. Business Name:

Question Title

* 2. Address:

Question Title

* 3. Hours of Operation:

Question Title

* 4. Phone:

Question Title

* 5. Fax:

Question Title

* 6. Contact Person:

Question Title

* 7. E-mail:

Question Title

* 8. This commitment includes:I would like to be a Participating Bike Shop:

Question Title

* 9. Name of Person Completing Form:

Question Title

* 10. I am authorized to make this commitment on behalf of this business.

Question Title

* 11. Why are you participating in Bike to Work Week 2011?

Question Title

* 12. Other comments:

* 8. This commitment includes:

I would like to be a Participating Bike Shop: