Apply here

First and Last name

Recovery Residence or Facility Name

Email

Phone

Why are you requesting a free E-Bike Rental code?

To attend treatment

To search for employment

To attend 12step meetings

To go to medical appointments

How often do you expect to use the E-Bike?

Daily

Several times a week

Weekly

Occasionally

Do you agree to inform RecoverE Bikes once you secure employment or personal transportation?

Yes

No

RecoverE Bikes –
Free Ride Program Application