EmailMe Form - Ghost Peloton Cyclist application

Name *

First Last

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

Date of birth *

DD / MM / YYYY

Gender *

Male

Female

T-shirt size *

Small

Medium

Large

X-Large

How would you describe your ethnic origin? *

Occupation *

Emergency contact name *

Emergency contact relationship *

Emergency contact phone *

Please provide details of any medical information relevant to your participation (if none please state 'N/A') *

Please provide details of any disability information relevant to your participation (if none please state 'N/A') *

If you cycle as part of a club, please tell us the name of your club. If not please state 'N/A'. *

Please confirm your cycling experience and skills *

Able to control bike while moving slowly & through tight spaces

Able to cycle one-handed

Confident drafting and riding in groups

Able to ride and stay in formation

Comfortable adapting speed

Comfortable riding in the dark wearing LED light equipment, with changing colours and effects

Experience in competitive cycling

Please tell us about your cycling experience - skills, club involvement, event participation, volunteering etc. *

Confirmation of availability for all event rehearsal and performance sessions. *

Please confirm that you will be able to attend all rehearsal and performance sessions for Ghost Peloton (18 & 25 Oct, 8 & 11-13 Nov)

Confirmation of own bike for use during event. *

Please confirm that you will provide your own drop-handlebar road bike for use during the event, that will be left within the secure production base for the event period (6-15 Nov) and fitted with temporary LED lighting technology

Please tell us about the bike you will be leaving with us during the production period and riding in Ghost Peloton. Please include all details of the make, model etc, and any other relevant information. (Please note that if you have one, this should be your second bike.) *

For insurance purposes please can you tell us the replacement value of your bike. *

Please provide us with photographs of your bike is possible.

We are interested in hearing about the emotional and physical reasons about why you cycle. Please tell us in less than 100 words why you cycle. *

How did you hear about Ghost Peloton? *

If you have any other information that you would like to share in relation to your Ghost Peloton application, please include it here.

Checkbox *

By ticking this box, you confirm that you have read and understood the details of participating on Ghost Peloton and the terms and conditions for taking part, as clearly outlined in the Cyclist Call Out document