Personal information
First name
Last name
Date of birth (You must be over 18 years old to register)
Day
01
02
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Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
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1932
1931
1930
You must me over 18 years old to register
Phone number
Email Address
Confirm Email Address
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Gender
Male
Female
Rather not Say
Specify Gender Below
Your Gender
Please let us know if you have any disability as we are keen to ensure this project is accessible to all
Not Applicable
Deaf or Hearing Impairment
Blind or Visual Impairment
Physical Disability
Intellectual Disability
Autism
Rather not say
Other (please specify below)
Other
Please indicate your cycling experience
New to Cycling
Occasional cyclist (2-3 times per year)
Regular cyclist (at least once a month)
Member of a Cycling Club
Other
Other
Please let us know where you first heard about the Community Bike Rides programme
Cycling Ireland website
Facebook
Instagram
Newspaper
TV Advert
Twitter
Radio
Word of Mouth
Your Local Sports Partnership/Local Authority
Other
Other
Address information
All leaders and participants can earn rewards when they complete a set number of Rides. Once you’ve reached a target (i.e. complete 10 Rides, receive a branded buff), you’ll receive your reward by post to this address.
Address Line 01
Address Line 02 (optional)
Town
County
Select County
Antrim
Armagh
Carlow
Cavan
Clare
Cork
Derry
Donegal
Down
Dublin
Fermanagh
Galway
Kerry
Kildare
Kilkenny
Laois
Leitrim
Limerick
Longford
Louth
Mayo
Meath
Monaghan
Offaly
Roscommon
Sligo
Tipperary
Tyrone
Waterford
Westmeath
Wexford
Wicklow
Eircode/Postcode (optional)
Emergency contact
In the event of an accident/incident taking place during a Ride, the Ride Leader will be able to access this information and inform the individual specified as the person to contact for you.
First name
Last name
Relationship to you
Phone number
Please provide details below of any medical condition the Ride Leader may need to be aware of in the case of an accident/emergency (i.e. asthma, epilepsy, allergic to penicillin etc). This information will be held in the strictest confidence and accessible to the Ride Leader in the event of an accident. It will only be shared with a third party (e.g. the Emergency Services) as necessary/appropriate.
Password
Enter Your password
Must be at least 8 characters long.
Must contain a lowercase letter.
Must contain an uppercase letter.
Confirm Your Password
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Error: Your password does not match the required criteria
For promotional purposes, the Ride Leader may take photographs before, during and/or after rides and these may be shared/posted on the Community Bike Rides’ website and related social media/web pages, and may also be posted on a Ride Leader’s personal social media to further promote their ride in their area. If you would prefer not to be included in any such promotional material, it is your responsibility to inform the Ride Leader before each ride takes place.
Connect with Cycling Ireland:
Cycling Ireland would like to contact you from time to time to:
inform you of national leisure events you may like to partake in
increase your awareness of Coach Education courses/workshops
provide you with the Cycling Ireland Ezine
Please check the box if you would like to receive communication from Cycling Ireland.
Confirm details
By checking this box, you acknowledge you have read and agree to our
terms and conditions
and
privacy policy
.
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