Essential Bike Commuter Nomination Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

May is Bike Month! Blue Wheel is looking for nominations from the community for essential workers who commute by bike. Each week throughout May we'll select one nominee to receive our Tune-Up Plus ($125 value) + replacement parts up to $75 in total value.

The selected nominees can either drop their bike at Blue Wheel for same-day service, or we'll meet them at their job, pick up their bike, and return it by the end of their shift!

Help us support Essential Worker Bike Commuters by nominating those you feel are in need of this service. You are welcome to nominate yourself! We're looking for candidates that work in grocery stores, schools, hospitals, and other services essential to our community.

Your Name *

Your Email Address *

Please enter an email address so we can coordinate with you if your nominee is selected.

Your Phone Number *

Nominee's Name *

Nominee's Phone or Email (Optional)

If you don't know the nominee's phone number or email, please leave this blank.

Nominee's Occupation & Employer *

Tell us more about your nominee and why you are nominating them. *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms