Miles of Freedom

6-Month Adventure Cycling Program Application

Please answer the following questions as honestly and in as much detail as possible.

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* 1. Please answer the following questions.

First Name

Last Name

Email Address

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* 2. How did you hear about Miles of Freedom?

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* 3. What is your branch and dates of service?

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* 4. Tell us a little bit about yourself

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* 5. What do you feel is your greatest challenge at this time?

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* 6. What is your desired outcome from participating in this program?

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* 7. What would that outcome be worth to you?

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* 8. Do you have any medical conditions that may impact your ability to participate in rigorous exercise?

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* 9. If selected, do you agree to meet all of the program requirements such as attending weekly planning meetings, participating in all cycling trips, and maintaining sobriety?

I agree

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* 10. Is there anything you'd like us to know?

Thank you. A representative from our organization will be in touch with you soon!