Bike East Bay Instructor Certification Interest Form

Please complete this form if you are interested in applying to Bike East Bay's Instructor Certification Seminar. Once you submit the form and your information is reviewed, a Bike East Bay staff member will send you the application when it is available.

Contact Information

First Name Last Name

Street Address (Optional)

Postal Code City State

Email Home Phone (Optional)

Yes, sign me up for email updates.

(Optional)

Application Prerequisites

I have completed the Smart Cycling Day 1 requirement and have sent my certificate of completion to Education@BikeEastBay.org

Yes No

I have completed the Smart Cycling Day 2 Road class requirement.

Yes No

When did you complete the Smart Cycling 2 Road class and with what organization? (estimate is OK)