SWIMBA Academy Application

Full Name^*

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Email Address^*

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Phone Number^*

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Age^*

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Do you currently own a bike? If so, please tell us year (if known), brand, model, condition.^*

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What type of bike would you like?^*

Dirt Jumper

Cross Country

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Please tell us what becoming a member of SWIMBA Academy would mean to you?^*

Please provide a short essay telling us how a new bike and lessons would impact your life.

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Link to Video

Please send us a short video to tell us a little bit more about yourself.

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Parent/Guardian/Responsible Adult^*

This submission has been made with the permission of a parent/guardian/responsible adult.

I am 18 or older.

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Parent/Guardian/Responsible Adult Signature (or Applicant 18 or over)^*

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