NEO Cyclist Discussion Interest Form Question Title * 1. Name (First and Last) Question Title * 2. Please share your email address Question Title * 3. Age Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 4. What is your gender identity? Woman Man Genderqueer or non-binary Agender Not specified above, please specify Question Title * 5. What county do you live in? Question Title * 6. Zip Code Question Title * 7. What is your ethnicity? (select all that apply.) American Indian or Alaskan Native Asian or Pacific Islander Black, African or African American Hispanic, Latino/a, or of Spanish origin White / Caucasian Prefer not to answer Other (please specify) Question Title * 8. How did you hear about this opportunity? ( organization or individual name) Question Title * 9. Have you done any of the following? Completed 50+ miles on the Towpath Trail Traveled for a distance cycling ride Completed a multi-day cycling trip None of the Above Completed a multi-day ride on the Towpath Trail Question Title * 10. How often do you cycle? (daily, weekly, monthly, a few times a year, etc.) Question Title * 11. What distance do you usually cycle? (<5 miles, 5-10 miles, 10-20 miles, 50 miles, etc.) Question Title * 12. Are you available to attend an in-person evening discussion group the week of June 2-6? Yes No Unsure Done