After you submit this survey, you will be led to a short (7 and 1/2 minutes) bike safety video from the National Highway Traffic Safety Administration. By providing us with your information below, you are stating that:

1. You will watch the safety video prior to taking the Be Well bike out for the first time
2. You'll wear a helmet at all times when riding a Be Well bike (you may bring your own helmet or use a Be Well helmet)
3. Before each ride you'll check to make sure the bike's lights work, the breaks, cranks, chains, and cassettes are working. We can help you with this if needed!
4. You'll wear bright clothing
5. You'll ride in the same direction as the traffic is going
6. You'll have fun!

Please provide your name and contact information as a record of you watching the video and fulfilling this portion of the safety requirements. When you're all done feel free to come and use the Be Well bikes anytime!

Question Title

* 1. Please enter your contact information below.

T