ACRP Ride4DEI Rider Application

Personal Information

Name*

First Middle Initial (optional) Last Suffix/Certifications

Date of Birth*

Email*

Enter Email Confirm Email

Preferred Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name*

First Middle Initial (optional) Last Suffix/Certifications

Emergency Contact Phone*

Cycling Information

Have you participated in multi-day long-distance cycling events before?*

Yes
No

If yes, please provide details.

Do you have experience with group rides?*

Yes
No

If yes, please provide details.

Do you have any relevant certifications or training in cycling? (e.g., cycling coach, first aid, etc.)

Fitness Requirements

To ensure the safety of all participants, we have established some fitness requirements. Please indicate if you meet these requirements:*

I can comfortably ride at an average speed of 12-15 miles per hour for long distances.
I am capable of cycling for extended periods (7-10 hours per day) for 5 consecutive days.
I am physically fit and free from any medical conditions that might prevent me from participating in this event.

Fundraising Commitment

Every rider is required to fundraise a minimum of $5,000 to support clinical research workforce diversity, which can be a combination of personal contributions and external donations.*

I agree

Fundraising Strategy

Please describe how you intend to secure contributions for the 2024 Ride4DEI.*

Mission

Why are you passionate about supporting clinical research workforce diversity?*

Additional Information

Please provide any additional information that you think is relevant to your application, such as special accommodations you may require during the event.

Declaration

By submitting this application, I confirm that all the information provided is accurate to the best of my knowledge. I understand the fitness requirements, fundraising commitment, and the purpose of this event. If selected, I am committed to fulfilling the fundraising goal of $5,000, which can be a combination of personal contributions and external donations.*

I agree
I do not agree

Selected riders will be notified in early Spring 2024 and will be asked to meet with event planning team for virtual check in calls on a biweekly basis. Thank you for your interest in ACRP’s Ride4DEI. Together, we can make a difference in promoting clinical research workforce diversity.

ACRP Ride4DEI Rider Application

Thank you for your interest in joining the 2024 ACRP Ride4DEI in support of clinical research workforce diversity.

2024 Ride4DEI Rider Application

Personal Information

Cycling Information

Fitness Requirements

Fundraising Commitment

Fundraising Strategy

Mission

Additional Information

Declaration

Clinical Research Transformation Survey

ACRP Ride4DEI Rider Application

Thank you for your interest in joining the 2024 ACRP Ride4DEI in support of clinical research workforce diversity.

2024 Ride4DEI Rider Application

Personal Information

Cycling Information

Fitness Requirements

Fundraising Commitment

Fundraising Strategy

Mission

Additional Information

Declaration