UHR 2023 Bicycle & Scooter Giveaway

Providing support and assistance

Bicycle & Scooter Application

  • Applicants must be 18 years of age or older. 
  • Due to limited supplies, the following application will assist in the selection process. Please provide as much detail as possible when communicating how receiving a bike or scooter will help you or your family.
  • Completing this application does not guarantee receipt of a bicycle or scooter. 
  • Form submissions must be received by 5:00 PM CST on January 25, 2023 
  •  All entries must be submitted electronically. 
  • One entry per household. 
  • There is no fee to apply. 
  •  Selection will be made by 5 PM on January 27, 2023. 
  • Selected recipients will be announced by 8 AM on January 30, 2023. 
  • Recipients must present required photo identification at pickup. 
  • Recipients must pick up before 5PM on January 31, 2023.  
  • Only one application per household.
  • Once submitted responses may not be changed. 
  •  Subsequent submissions will not be considered. 
Selected recipients will notified by email. Please provide you most up to date email address. Read Terms And Services Below
Testimonial & Participation Release

By continuing and submitting this application, I,  the named applicant (individual completing and submitting this form), hereby irrevocably consent to grant United Hands Relief, Inc., a 501 c (3) non-profit organization, its authorized agents, assigns, successors and affiliates (Collectively “UHR”), the nonexclusive, royalty-free, worldwide right to publish, reproduce and use, in whole or part (collectively “Grant for Publication”) the applicant’s testimonial (“Testimonial”) and participation (“Participation”) in connection with UHR’s business in all forms of communication including but not limited to print, hard copy publications, advertising and collateral material, television, radio, electronic and digital media (such as CD-based multi-media and mobile apps), video, email, online advertising, mobile advertising, intranet and internet sites (inclusive of social media sites), search engine optimization and/or their related websites (collectively “Media”), and all associated Terms of Use/Service of the “Media”. 

 I agree that in place of a signed signature the submission of this form, nullify the need for a signature and will constitute a binding legal agreement. I have full power and authority to grant the rights stated above. I confirm and I represent that I am not a minor (for legal consent purposes). I confirm and represent this Grant for Publication does not infringe the copyright, trademark or any other proprietary or privacy right of any other party. I specifically acknowledge that I am not entitled to receive any financial compensation from UHR in exchange for the use of my name and testimonial either now or at any time in the future. 
UHR is not responsible for the content, accuracy or date of the item(s) listed above. I release UHR from any claims and expenses arising from its use of the Testimonial in the Media. I release UHR from any liability connected with UHR’s use of the Testimonial or Participation in the Media and will indemnify, defend and hold harmless from and against any claim rising in connection with a breach of the foregoing representations. 

Sign-Up Form

    Your Donation Cart
    Your cart is empty