Sears National Kids Cancer Ride » Apply for 2016 Ride

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Name (first, middle, last) *

Address (number, street, apartment)

City

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Postal Code

Email Address *

Home Phone Number (including area code)

Mobile Phone (including area code)

Gender

Height

Weight

Date of Birth

List and provide details of any medical conditions that may impact your training prior or during the event? *

What athletics do you currently participate in (include both competitive and recreational sports)? *

Describe the most adventurous athletic event you have participated in, and what prompted your involvement? *

How many times per week do you engage in aerobic activity for periods of longer than 60 minutes? *

Choose the answer that best describes your current level of fitness? *

Please describe why you want to be one of the National Riders on the Sears National Kids Cancer Ride? *

Please describe why you think you are a good candidate for the Sears National Kids Cancer Ride? *

Have you (or someone close to you) ever been impacted by cancer? *

Are you confident that with the appropriate training and nutritional plan, you will be able to complete the Sears National Kids Cancer Ride? *

Please indicate how you heard about the Sears National Kids Cancer Ride? *

Please provide three references that support your participation in the Sears National Kids Cancer Ride? *

Please outline previous charity and non-charity events you have participated in? *

Any other comments or thoughts?

Apply for 2016 Ride