COMMUTER INFORMATION
First Name: *  MI: 
Last Name: *
Note: You must enter a valid working e-mail. This is critical as we will use your e-mail address to contact you regarding rewards, prizes, and other important program information. In addition, IF you choose to participate in ridematching, your e-mail address will be shared with your matches.
 
  Uncheck if you don't want to share your email-address with others.
E-mail: * 
 
Confirm E-mail: * 
Password: * (Must be 4 to 10 characters)
Confirm Password: * (Must be same as Password)
 


CONTACT INFORMATION
 
  Uncheck if you don't want to share your phone numbers with others.
Home Phone Number: - - *
Mobile Phone Number: - -
Work Phone Number: - -    Ext:
 


HOME ADDRESS
* Complete address information will not be shared with others.
Please do NOT enter PO Box addresses here as they are not useful for ridematching.
Street Address: *  Apt #: 
City: *
County: *   
State: *       Zip Code:  *
 
Check here if mailing address is different
 


COMMUTE INFORMATION
Current Commute Mode: *
Work Schedule: : :   To:   : : *
Commute Days:Please select the days of your commute in a week
   Mon.   Tue.   Wed.   Thu.   Fri.   Sat.   Sun. 
 
Additional Work Schedule Notes:
(Maximum 100 characters)
 
What best describes your trip to work during the past 2 years?
  *
(clean commute = carpool, vanpool, transit, bike, walk, telework)


RIDEMATCH INFORMATION
Match Preference: *
Carpool Preference: *
Vanpool Preference: *
My work hours are flexible by minutes to accomodate a carpool or vanpool.
Would you like to find a bike buddy?   *   (Find commuters interested in cycling to work)
 
Add any information you want to share with other commuters (e.g. Non-smoking, No Food):
(Maximum 100 characters)
 


ADDITIONAL INFORMATION
How did you hear about us? *
Would you like to receive the CommuteSmart quarterly newsletter, The Route? *
 


DISCLAIMER


 
* Required Fields