Your details

Name*:
Postal address House Number/Building Name & Street Name*: Area*: Town*: Postcode*:
Email*:
Telephone Number:
Mobile Number:

Your cycling interests

The following information will help KBUG better represent the interest of cyclists.
Are you able to ride a bicycle?	Yes No
Do you own or have access to a bicycle?	Yes No
When do you cycle?	-- choose -- All year round Mostly in the summer
How many days a week do you use your bike for leisure?	-- choose -- 1 2 3 4 5 6 7 rarely never
How many days a week do you cycle to work?	-- choose -- 1 2 3 4 5 6 7 rarely never
What kind of cycle training is likely to be of most benefit to you? eg. learning how to ride a cycle, developing more skills and confidence for cycling in traffic, acquiring advanced skills for handling a range of urban cycling environments)

Cycling Lifestyle

What kind of cycling appeals to you most? (please rank 1 - 6, 1 being most important and 6 least important)
1. Commuting	-- choose -- 1 2 3 4 5 6
2. Utility Cycling (shopping, visiting friends, local trips)	-- choose -- 1 2 3 4 5 6
3. Leisure/recreational/fitness cycling on quiet roads.	-- choose -- 1 2 3 4 5 6
4. Off-road (mountain biking)	-- choose -- 1 2 3 4 5 6
5. Family cycling mostly on cycle tracks/paths free from traffic	-- choose -- 1 2 3 4 5 6
6. Other (please specify below)	-- choose -- 1 2 3 4 5 6
6a. Please specify for other

Where and when?

Our usual base for cycle training is at the Highways HQ at Flint St, Fartown, Huddersfield and our pattern has been to go for weekdays, around 5.30pm - 7.30pm from Easter to Autumn (two evenings initially, followed by subsequent sessions for those wishing to gain a national standard qualification).
Is Fartown a convenient base for you to get to with your cycle?	Yes No
If not, where would be convenient?
What days/times would suit you best?
Weekdays Choose the days you are available	Monday	am pm evening Any time
	Tuesday	am pm evening Any time
	Wednesday	am pm evening Any time
	Thursday	am pm evening Any time
	Friday	am pm evening Any time
Weekend Choose the days you are available	Saturday	am pm evening Any time
	Sunday	am pm evening Any time
Term time School holidays (If important)
We are more than happy to discuss your individual needs in relation to cycle training, so please do give us a ring to find out more about what might be available.