2024 Cycling PARTICIPANT Registration Form

2024 Cycling PARTICIPANT Registration Form

Participants only need to complete ONE form for the year.
Participant Type*
Participant Sub-type*
Branch of Service*
Rank
Last Name*
First Name*
Birth Date*

MonthDayYear
Date
Disability Type*
Disability Sub-Type*
Date of Injury

MonthDayYear
Date
Place of Injury
Gender*
LGBTQ*
Race*
Hispanic, Latino or Spanish Origin*
Address*
City*
State*
Zip*
Cell Phone*
Home Phone*
E-mail*
I want to register for the following TRAS Cycling Series date(s):*

May 18thJune 8thJune 15thJune 23rdJuly 13thJuly 27thAugust 10thAugust 24thSeptember 14thSeptember 28thOctober 12th
NOTE: Registration and TRAS Liability Releases Must Be Received ONE WEEK prior to selected date(s) above.
Cyclers must be 210lbs or less and must be able to fit into an 18" wide wheelchair.
Personal Information (please be as specific as possible):
Please choose your most frequent mode of mobility:*

WalkingManual wheelchairPower wheelchairOther
If 'Other', please specify:
Please list any assistive devices or braces used*
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?*

YesNo
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.*
Clicking the 'Submit' button will take you to the REQUIRED Liability Waiver Form.
Should be Empty: