Cycle Buddy Trainer

Do You want to be a Bicycle Buddy trainer?

If so please fill out the form below

BBVT Bicycle Buddy Volenteer Trainer

Please note that all fields followed by an asterisk must be filled in.

CUSTOMER, First and Last Name*

Last Name*

E-Mail Address*

Web Site URL

Street Address*

C I T Y and Postal / Zip Code*

State/Prov*

Zip/Postal Code*

Country*

Cell Phone 1-*

Alternative Phone 1-

Gender, Age, Hieght, weight

Please select what best descibes you

	I have a current First Aid Certificate w/AED (within last 1-1/2years)
	I need to update me First Aid Certificate w/AED
	I have experince in trauma cases
	I have studied phsycololgy
	I have a strong sales background
	I am experiemced in emergency response issues
	I am a cycling instructor/trainer
	I have been educated/trained as a instructor/trainer
	I will provide a current Criminal check clearance
	I am Mechanically inclined
	I have experience servicing bicycles
	I need training on how to service bicycles
	I ride seasonally
	I ride all year round (indoors/outdoors)
	I am a spinning instructor, and want to ride outdoors
	I've ridden competitively
	I just like riding!
	I'm an old fart and would enjoy taking other out for a ride!
	I ride twice a week,
	I ride three times per week
	I ride four times per week
	I ride daily
	I have College level education
	I have University level education
	other

Distances you have cycled in the past and present, (include year distance was achieved)

Add'l credentials that would benefit an cycling experience

Other sports you enjoy participating in

Comments (Best descibes you)

We pay for your mileage. are you willing to travel within Central Ontario?

	Yes
	No

Up to whjat distance or time are you willing travel to join a Bicycle Buddy to train them?

For relatability to our clients, please list at least three things about your working career or back ground experience

Tell us about yourself