Bike to Work - Coffee Shop Registration 2011

1. Commuter Coffee Shop Registration

Question Title

* 1. Business Name:

Question Title

* 2. Owner/Manager:

Question Title

* 3. Address:

Question Title

* 4. Additional Locations:

Question Title

* 5. Hours of Operation on Friday, May 20, 2011:

Question Title

* 6. Contact Person (if different than Manager/Owner):

Question Title

* 7. Phone:

Question Title

* 8. Fax:

Question Title

* 9. E-mail:

Question Title

* 10. My coffee shop will participate in Bike to Work Week by:

Displaying Bike to Work Week poster(s) before the event (these will be provided to you)

Providing a free small cup of coffee to cyclists who show their helmets on May 20th from 7am to 9am (unless outside of normal operating hours). If you’d like to do more please let us know (additional hours, days or no limitation on beverage)

Question Title

* 11. Name of Person Completing Form:

Question Title

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

Question Title

* 13. Other comments: