Survey - Bike MS: 2012 Responsible Cyclists (RC) Pledge

Bike MS: 2012 Responsible Cyclists (RC) Pledge

Note: This form is intended for cyclists who participated in a Group Riding Skills Course in 2010 or 2011.

If you registered for a GRS course in 2012, you do not need to complete this form and we look forward to seeing you at the course. Once you attend, you will automatically be designated as a Responsible Cyclist for 2012.

Deadline: September 14.

Please enter your contact information:

If you have previously registered, please to prepopulate your information.

Name:

Title

First Required

Last Required

Suffix

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State/Province Required	ZIP/Postal Code Required

Phone Number: Required

Gender: Required

Date of Birth: Required

Date of Birth:

Month

Day

Year

Yes, I would like to receive important e-mail updates from the National MS Society.

Email Format:

Yes, I would like to receive important postal mail updates - including event announcements - from the National MS Society.

Remember me. What's this?

*2.

Question - Required - How many years have you participated in this event (enter 0 if this is your first year):

Question - Not Required - Team name (if applicable):

*4.

Question - Required - Are you a team captain?

With 7,000 riders on the road City to Shore weekend, it is important that each cyclist set a good example by following the rules of the road and respecting the communities we ride through. Unfortunately, the future of the ride is constantly in jeopardy due to the inconsiderate and dangerous behavior of some City to Shore cyclists. Thank you for your dedication to City to Shore and for your past participation at a Group Riding Skills Course. We appreciate your willingness to pledge yourself as a safe, courteous and responsible cyclist at City to Shore again this year.

*5.

Question - Required - As a Responsible Cyclist, I...
Please make 6 selections from the choices below.

	Pledge to ride as a model cyclists and promote safe and courteous cycling behavior throughout City to Shore weekend by following the rules of the road and the Bike MS: City to Shore Ride.
	Attended one Group Riding Skills (GRS) Course in 2010, 2011 or 2012
	Will attend the Responsible Cyclist Conference Call, (for 2010 or 2011 GRS participants, please pick your time below)
	Will review the safety brochure, N.J. state laws, and Bike MS Emergency Protocol prior to the ride. (These will be mailed to you in September and are available online.)
	Will wear my blue RC sticker the weekend of the Ride. (Will be mailed to you in September.)
	Understand that no first aid knowledge is required.

*6.

Question - Required - Which Responsible Cyclist conference call will you attend?

*7.

Question - Required - What is your most memorable GRS Course experience?

(Maximum response 255 chars, approx. 5 rows of text)

Share your passion for safety and recruit a friend!
We need your help to ensure the future of the ride. Spread the word about the importance of safe and courteous cycling behavior during City to Shore weekend.

How you can help:

Be an official spokesperson! Tell all your cycling buddies about the Responsible Cyclist program.
Promote the GRS course you are attending -- recruit cyclists to sign up!
Help us make phone calls to get others involved.

National MS Society - Greater Delaware Valley Chapter

30 South 17th Street, Suite 800
Philadelphia, PA 19103