New Registration

Thank you for your interest in Pedaling for Parkinson’s.  Please complete the fields below to become a registered user.  You will be notified by email when your account is activated. Thank you.

 

Please complete all fields  on this form.You may also view or download the users guide here for instructions, copies of waviers etc. NOTE: YOUR USERNAME WILL BE YOUR EMAIL ADDRESS
Address Line 1  *
Address Line 2
City  *
State or Region  *
Zip  *

Your password must be a minimum of 8 characters including at least one number and one capital letter.

Password must be at least 8 characters including at least one number and one Capital Letter
Password must be at least 8 characters including at least one number and one Capital Letter
By checking this box and submitting this form you confirm that you have read and agree with our Privacy Policy.
I agree and accept the medical disclaimer below.
You must read the medical disclaimer before you can accept the terms.

To complete registration and use this website, you must read and agree to the exercise waiver form. When you click the box you are confirming that you have read the exercise agreement and agree to hold SRQ Pedals.com harmless for any medical issue.  (Note you must scroll and read the entire document before you can click the box.)

You may download a copy of the waiver here.

I agree and accept the terms and conditions for participation in Pedaling for Parkinson's exercises.
You must read the exercise waiver before you can agree to the terms.
   

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