2013 Point West Bike Subsidy Program

Name: Required
TMA Member Employer: Please select an item.
Residential Address: Required
City: Required
Zip: RequiredInvalid format.
Email: RequiredInvalid format.

What are you requesting the subsidy be used for?

Please select an item.

Approximate cost of the above:

$ RequiredInvalid format.

Amount of subsidy requested:

$ RequiredInvalid format.
 

Briefly explain why you are applying for this subsidy.  Include details of your bike commute, cycling history, and need for the new bicycle/accessory. Required

 


Optional:
  Attach any additional pages, including letters of support and endorsement here.

Attachment 1:
Attachment 2:
Attachment 3:

Applicant agrees to log a minimum of 12 bike commute trips during May 2013 on the May Is Bike Month web site.  (www.mayisbikemonth.com) Applicant agrees to complete and pass a Bicycle Safety Test prior to receiving subsidy funds.

Applicant agrees to defend, indemnify and hold  harmless the TMA, its officers, agents, employees and volunteers from any losses, costs, damages, fines or expenses; or liability of any kind arising or alleged to arise from any breach of the responsibilities required of the participants by this agreement or which are related in any way to the bicycle/accessory for which financial assistance or other incentives are received.

Applicant agrees to cooperate with the TMA in promoting the program.

Required I have read, understand and agree to the terms described above.