* 1. Have you been in a crash or near crash involving a bike in Newport, RI?

* 2. What was the date or approximate date of the incident?

* 3. Location of the crash or near-crash

* 4. Please check all of the following that apply:

* 5. Please describe the incident to the best of your recollection. Please include time of day, road conditions, a description of the crash or near-crash, and any details you wish to share.