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* 1. Date

Date

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* 2. Are you interested in being a Mentor or Mentee Bike Buddy?

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* 3. If you are a Mentor, are you a member of Bicycle NSW?

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* 4. Name

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* 5. Year of Birth

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* 6. Preferred Pronoun

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* 7. Suburb

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* 8. Email address

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* 9. Mobile number

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* 10. If you are a Mentee, please answer: How confident do you feel riding in your own neighbourhood? 1 = Not confident; 10 = Very confident.

0 10
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i We adjusted the number you entered based on the slider’s scale.

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* 11. If you are a Mentee, please answer: How safe do you feel riding in your own neighbourhood? 1 = Not safe; 10 = Very safe.

0 10
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i We adjusted the number you entered based on the slider’s scale.

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* 12. If you are a Mentee, please answer: How often do you ride your bike in your own neighbourhood? 1 = Not often; 10 = Very often.

0 10
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i We adjusted the number you entered based on the slider’s scale.

T