It is important that all riders on training rides have
easily accessible emergency medical information.
Please fill this out, have it laminated, and
carry it with you on all training rides.
EMERGENCY MEDICAL INFORMATION
MY NAME IS: ___________________________
RIDER #: _________ BLOOD TYPE: ________
ALLERGIES: ___________________________
OTHER IMPORTANT MEDICAL INFO:
_________________________________
_________________________________
HEALTH INS CARRIER:________________
Ph #: ______________POLICY #:________
Primary Care Physician: _________________
Phone #:_____________________________
IN CASE OF EMERGENCY, CONTACT:
NAME: ________________________________
Ph #:______________ Relationship:_________
NAME: ________________________________
Ph #:______________ Relationship:_________