FORM RegoSCC v2

1. How often do you currently...

Rows	None	1x week	2x week	3x week	4x week	>4x week
Ride your bike?
Engage in non-cycling exercise?

2. How do you rate your current level of confidence about...

3. How do you rate your current level of fitness?

Rows	Below Average	Average	Good	Very Good	Excellent
Fitness

4. What type of bike do you have?

Other
5. Do you have cycling shoes with cletes & 'clip-in' pedals?
6. Can you ride with one hand (for drinking, signalling etc)
7. What is the longest ride you have done?
8. What are your expectations of this program/session?
9. Any health issues?
10. How did you hear about Sara Carrigan Cycling?
11. Other notes
Other Participants

Attending Private Group Session
PLEASE NOTE: It is a requirement for each participant to complete the registration form PRIOR to the session. Attendance is not permitted without a completed registration form.

Please list the other participants below and they will be contacted to complete the registration form.
-- PARTICIPANT 2
Participant 2: Name

First NameLast Name
Participant 2: Email
-- PARTICIPANT 3
Participant 3: Name

First NameLast Name
Participant 3: Email
-- PARTICIPANT 4
Participant 4: Name

First NameLast Name
Participant 4: Email

Terms and Conditions
Bike & Safety
Participant Name

First NameLast Name
Name of parent/legal guardian (if participant under 18)
I am authorised to accept Terms & Conditions as parent/legal guardian of the Participant
Registration Date

DayMonthYear

Cycling Skill SessionFree

Type of SessionQuantity

Travel Fee$80.00 AUD

Please select if your session will be held outside the standard service area.

Enter coupon

Subtotal Tax Total $0.00 AUD

REGISTRATION FORM