Trishaw Ride Interest Form

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Are you interested to receive free trishaw rides or know someone who does?
Cycling Without Age Singapore (CWAS) exists to provide free trishaw rides to seniors and people with limited mobility/disability! We would love to hear from you via this simple form:

*please note: the trishaw can only carry two passengers per ride.

Your Name *

Phone Number *

Where would you like to go for a trishaw ride? *

Ang Mo Kio (Bishan Park)

Gardens by the Bay

Jurong Lake Gardens

Required

Is this trishaw ride for yourself or for a loved one/friend? *

Responding for myself

Responding on behalf of someone else

Name and Age of trishaw passenger(s) *

example: Nancy Tan, 67

How did you found out about this opportunity? *

Social media (Instagram, Facebook and Linkedin)

Friend’s recommendation

Google search

I saw the trishaw in the parks!

Other organisation (please write the name of the organisation under others)

Other:

Required

By completing this form you agree to be contacted by a CWAS representative about CWAS trishaw and engagement activities via phone, email or WhatsApp. *

I consent to being contacted by a CWAS representative

Required

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