Ride2Work Registration Question Title * 1. Personal Details First Name Last Name Email Address Mobile Phone Year of birth (eg. 1975) OK Question Title * 2. Gender Woman Man Non-binary / Gender diverse Prefer not to say I prefer to self describe OK Question Title * 3. Traveling From - your residential address Street (optional) City or Suburb State Postcode OK Question Title * 4. Travelling to - your workplace address Organization Street or Building Address (eg. 2 Green St) City or Suburb State Postcode Department (for large workplaces, eg Finance) OK Question Title * 5. When I ride I'm usually Road cycling Commuting CX (cyclocross) Racing Riding for leisure I'm new to riding OK Question Title * 6. Your Riding Habits I used to ride but don’t anymore I have never ridden to work I am planning to start riding to work I have tried riding once or twice I am riding to work about once or twice a month I am riding to work once a week I am riding to work twice a week I am riding to work three times a week I am riding to work four times a week I am riding to work five times a week OK Question Title * 7. Have you participated in Ride2Work day before? Yes No OK Question Title * 8. My Ride2Work goal is to... Ride to work on Ride2Work Day Ride to work for the first time Ride to work more often Help someone else start riding to work Help make my workplace more bicycle friendly OK Question Title * 9. Would you like to be a Workplace Coordinator? Yes No OK Question Title * 10. Can we share your name and email address with the workplace coordinator registered for your workplace? Yes No OK Question Title * 11. I want to hear more about Bicycle Network's... Rides and events Advocacy - campaigns and programs Tips and training resources Membership Volunteer opportunities OK Question Title * 12. Terms and Conditions I agree to the terms and conditions OK NEXT
