Sign Up – Park Pedal

1. Enter Your First Name:

2. Enter Your Last Name:

3. Enter Email:

4. Enter a Password for your account:

5. Please provide details of a person we could contact In Case of Emergency:

ICE Name:

ICE Phone Number:

6. Please provide your postcode:

7. Your Age:

Under 18

18 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 +

8. Your Gender:

Male

Female

Other

Prefer Not To Say

9. We are working hard with the Whitlingham Trust to establish cycling facilities
Please tell us if you would use the facilities:

Very Likely

Likely

Not Very Likely

10. How often do you cycle now?

Daily

A few times a week

A few times a month

11. If these cycling facilities existed at Whitlingham, how often would you ride?

Much more than I do now

Maybe a little more than at the moment

About the same

12. If you have a Park Run ID and would like to use your Park Run barcode for Park Pedal, enter it below: