Survey - Pedaling for Parkinson's Online Registration Form

Pedaling for Parkinson's Online Registration Form

PFP Online is a virtual class offered several days a week. Sign up below to gain access to our complete schedule of online classes and stay in the know about new offerings.

Note: If you are looking to sign up for an IN PERSON Pedaling for Parkinson’s class, please refer to our list of classes and contact the facility to register.

Enter your information:

Field Is Required First

Field Is Required Last

Date of Birth:

Street 1:

Street 2:

City/Town:

State / Province:

Field Is Required ZIP / Postal Code:

Country:

Field Is Required Email:

Phone Number:

Click here if you would like to receive Davis Phinney Foundation news and updates via email.

Field Is Required Would you like to be added to our Pedaling for Parkinson's email list?

Check this box if you would like to receive Pedaling for Parkinson's news and updates via email.

Field Is Required What is your relationship to Parkinson's?

Field Is Required To which gender do you most identify:

If you selected "prefer to self-describe" or "other," please describe here:

What year were you diagnosed?

Field Is Required Have you participated in a Pedaling for Parkinson's class (either in-person or online) before?

Field Is Required Emergency Contact Name:

Field Is Required Emergency Contact Phone number:

Field Is Required Relationship to You:

How did you hear about PFP Online?

Read and acknowledge the waiver here. By submitting this form, you are consenting to the contents of this waiver.