Volunteer Pilot Application
Thank you for your interest in volunteering as a pilot for the Sebastopol Area Senior Center's Trishaw Program. Please complete this application and we will get back to you as soon as possible.
Your contact Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name
*
First Name
Last Name
Relationship to you:
*
Spouse, sibling, friend etc
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Program Information
Do you feel comfortable helping people in and out of the trishaw?
Do you have a cell phone to use in case of emergency?
Do you have any experience with bicycle maintenance?
Do you have any medical conditions that may affect your ability to participate in Cycling Without Age (heart conditions, vision difficulties, etc.)?
What is your experience with cycling?
Why do you want to become a Pilot for Cycling Without Age?
Submit
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