Geneva College

 

 

Geneva Across America: Pennsylvania Application


A paper application is also available if you would prefer to submit your information via hard copy:

Complete the form below to register for Geneva Across America: Pennsylvania

Contact Information
Name *
Date of birth *
Primary email address *
Cell phone number
Geneva address (Hall/Room/Office)
Box number
Home address
Emergency Contact Information
In case of emergency please contact: *
Cell phone number
Email address
I am applying as a *
Student
Staff
Faculty
Alumni
Friend of the College
Previous Bicycling Experience
What is your level of cycling experience? *
Beginner
Intermediate
Advanced
Expert
Professional/Semi-professional
Beginner: I know how to ride but have never been on an organized bike trip for more than a day.
Intermediate: I’ve done week long trips, own spandex, and ride a lot during the summer.
Advanced: I have been on multi-week trips or ride regularly, have several bike jerseys and rain gear, and/or belong to a bike club and can perform simple bike repairs.
Expert: I’ve crossed a mountain range in a single day, ridden several races, enjoy doing centuries, and can repair my bike in the dark with a pocket knife.
Professional/Semi-professional: Ride with a team during the summer, I can fix my bike with a paperclip, duct tape and a rubber band, enjoy camping, and would consider a cross country ride in 2020.
Please list any bicycling trips you have been on in the past:
What is the highest number of miles you have ridden in one day? *
GAA: PA will finish with a couple of hilly days. That said, what is the most hilly/mountainous route you have done?
Insurance Information
Each team member will be responsible for providing proof of medical insurance.
Insurance Company *
Insurance card number *
SWAG Information
Bike Jersey Size *
T-Shirt Size *
Hat Size *
Sock/Shoe Size *
Windbreaker Size *
Other Information
Why do you want to participate in Geneva Across America: Pennsylvania? *
By being accepted for the Geneva Across America trip you agree to:
A. Fully participate as a member of the Geneva Across America: PA team in each day of riding.
B. Conduct yourself with integrity and compassion, as an ambassador of Geneva College and its mission.
C. Follow the training and preparation instructions of the team leaders.
D. Accept all liability for personal safety and release Geneva College, its employees, and trip leaders from all liability both now and in the future.
E. Abide by the policies, procedures, and instructions as outlined by the literature and team leaders.
F. Accept responsibility for all financial obligations associated with the trip ($400 for the trip).
G. Submit all necessary paperwork in a timely manner.
H. Fully engage in the fund raising effort of the trip (raise a minimum, of $100 for the scholarship).
I. Accept responsibility to have one’s bicycle examined, tuned, and prepared by a professional bike mechanic and accept responsibility for all repairs during the trip.
J. Allow Geneva College to use your image and quotes in future promotional materials.
Pricing Structure
A. A non-refundable deposit of $50 is due with this application.
B. Balance ($350) is due by Friday, May 30th.
C. Fund raising dollars are due by June 30th
Signature *
Date *