Warrnambool Cycling Reference Group - Expression of Interest

Thank you for taking the time to submit an Expression of Interest to join the Warrnambool Cycling Reference Group. Information provided will be used only for the purposes of this Expression of Interest process, and will be treated in accordance with our Privacy Policy.

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* 1. Name

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* 2. Email

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* 3. Phone Number

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* 4. How do you identify your gender?

Man/Male

Woman/Female

Non-binary

Prefer not to say

I use a different term

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* 5. What is your age range?

Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

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* 6. What is your interest in cycling? Please tick all that apply

As a method of transport

Recreation

Road racing / road cycling

Mountain bike riding

BMX riding

Other (please specify)

Warrnambool Cycling Reference Group - Expression of Interest

Question Title

* 1. Name

Question Title

* 2. Email

Question Title

* 3. Phone Number

Question Title

* 4. How do you identify your gender?

Question Title

* 5. What is your age range?

Question Title

* 6. What is your interest in cycling? Please tick all that apply

Question Title

* 7. Please provide any supporting comments relating to your expression of interest (eg. experience, expertise, interests)