Bublr Bikes Access Pass


The Bublr Bikes Access Pass is a program that allows qualifying residents who possess a food share benefits card, receive Medicaid or SSI benefits, or are residents of Section 8 housing, to receive a discounted Bublr Bikes Annual Membership (traditionally $100)


Please fill out this form so we may determine your eligibility. After submitting the form and payment you will be mailed a special Access Pass Card that you can use at any Bublr Bikes Station to check out a bike.

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Pass type: ANNUAL PASS (365 days Rain/Snow or Shine)

COST: The Bublr Bikes Access Pass is currently available for FREE thanks to Anthem Blue Cross Blue Shield!

TRIP TIME: Members with this annual pass type are allowed to take trips up to 60 MINUTES at a time. Check your bike in after 60 minutes of riding? No problem, you can check the Bublr Bikes right back out again and keep riding! You can take as many 60 minute Bublr Bike trips daily/weekly/monthly/yearly as you like as long as you honor the pass type TRIP TIME ALLOWANCE.

Funding for this program is provided by Anthem Blue Cross Blue Shield.

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Do you receive Foodshare, Medicaid, SSI, or live in Section 8 Housing? (check all that apply) *
Required
If you receive Medicaid please let us know your Medicaid Insurance Provider *
First Name *
Last Name *
Home Address *
Zip Code *
Phone Number *
Email Address *
If you don't have a credit/debit card and need to sign up in person with a photo ID please check here.
Referred By: *
What does access to Bublr Bikes mean to you?
(Response is optional & may be shared as a testimonial to let our supporters know how their contribution makes an impact.)
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