Personal Data

We kindly request that anyone participating in our Health Ride programme completes this registration form so that we have your up-to-date contact details and are aware of any health issues that may affect your response to exercise. By providing this information through this form we can add it directly to our database and it saves time in completing a paper form when you arrive for your first ride.
 
Rest assured that any data is treated in the strictest confidence and we would never disclose this to anyone outside Trailnet without your express written permission, although we do use anonymous, collated data for reporting to funders and statutory organisations.

Are you a current, returning or new rider with Trailnet?

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* 1. Are you a current, returning or new rider with Trailnet?

What is your first name?

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* 2. What is your first name?

What is your last name?

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* 3. What is your last name?

What is your gender?

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* 4. What is your gender?

Date of birth

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* 5. Date of birth

Date / Time
What is your mobile phone number?

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* 6. What is your mobile phone number?

What is your email address?

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* 7. What is your email address?

In which district do you live?

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* 8. In which district do you live?

Emergency contact name

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* 9. Emergency contact name

Emergency contact number

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* 10. Emergency contact number

Which of our current rides are you interested in?

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* 11. Which of our current rides are you interested in?

Please use the space below to tell us anything that you think we need to know regarding your cycling background, goals or why you want to cycle with us?

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* 12. Please use the space below to tell us anything that you think we need to know regarding your cycling background, goals or why you want to cycle with us?

If there are other rides that you'd like us to consider, please specify below:

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* 13. If there are other rides that you'd like us to consider, please specify below:

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