WilCo Wellness Alliance Bike to Work

Registration Form

The following questions will be used to determine the overall frequency and distance of bicycle commuting as well as safety and convenience of using bicycles in Georgetown and other Williamson County communities. If you would like to be included in a drawing for this event please complete the information to hear about future WilCo Wellness Alliance events.

The information you provide in this form will not be shared with anyone other than the WilCo Wellness Alliance staff. If you have any questions please contact Marcus Cooper at mcooper@wcchd.org or 512-943-3672. Thank you!

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* 1. In what city do you live?

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* 2. In what city do you work?

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* 3. How often do you bike to work?

Everyday

3-4 days a week

1-2 days a week

Less than once a week

This is the first time

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* 4. What is the estimated distance from your home to your work?

0-2 miles

3-5 miles

6-10 miles

Over 11 miles

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* 5. How familiar are you with road/bike safety?

What's that?

Not at all

Somewhat

Very

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* 6. What would make you feel more comfortable biking to work? (check all that apply)

Bike safety class

Bike lanes

Better road signage

Other (please specify)

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* 7. Is there bike parking at your workplace?

Yes

Not sure

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* 8. How did you find out about this event?

Website

Facebook

Twitter

Other (please specify)

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* 9. Comments

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* 10. Would you like information on future WilCo Wellness Alliance events?

Yes

Maybe