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Employee NameFirst NameLast Name
Employee Email Address
Work Phone Number - -
My round-trip bicycle commute trip is miles.
I have bicycled to work in the last 12 months
I get to work most of the time by:
I hereby assume all risks inherent in any physical activity and release and hold harmless any event organizers and their employees of any and all claims and liabilities and am fit to participate in this event.
I pledge to bicycle to work at least 1 day during Bike to Work Week May 17 - 21, 2004
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