TRAS 2022 Cycling Participant Registration Form

Email *

example@example.com

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Date of Birth *

Gender *

Female Male

I want to register for the following TRAS Cycling Series date(s): *

June 4th July 9th August 13th Sept. 10th October 1st

NOTE: Registration and TRAS Liability Releases Must Be Received ONE WEEK prior to selected date(s) above.

Personal Information (please be as specific as possible):

Disability: *

Date of Onset: *

Height *

Weight *

Cyclers must be 210lbs or less and must be able to fit into an 18" wide wheelchair.

If your main mode of mobility is walking and you use any assistive device, please note it here. *

If you use a wheelchair, is it manual or motorized? *

Any previous cycling experience and equipment used (since disability): *

List other sports you participate in on a regular basis. *

Are you currently under a doctor's care for any condition? If yes, please explain. *

Are you allergic to anything [i.e. food, sun, medication]? If yes, please explain. *

Do you need to limit your activities for any reason? If yes, please explain. *

Do you have seizures? *

Yes No

Within the past six months, have you had any injury to, or surgery on your back, spinal cord, or hips? If yes, please explain. *

Do you wear a back brace or have Harrington Rods? If yes, please describe. *

Are there any other special medical conditions TRAS should know about (asthma, diabetes, heart trouble, etc.)? If yes, please explain. *

List medications you are currently taking: *

Provide an Emergency Contact Name, Phone number, and Relationship to you. *

Registration Deadline is one week in advance of selected date(s)