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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