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Dump the Pump 2008
1. Please fill out the questions below.
I pledge to be part of the pollution solution and to do my part at least once during the week of June 16-20, 2008.
*
1
. Full Name
Full Name
*
2
. Home Address
Home Address
*
3
. City
City
*
4
. Zip
Zip
5
. Home Phone
Home Phone
*
6
. Home E-mail (so we can e-mail you if you win a prize)
Home E-mail (so we can e-mail you if you win a prize)
*
7
. Employer
Employer
8
. Employer Address
Employer Address
*
9
. City
City
10
. Zip
Zip
11
. Work Phone
Work Phone
12
. Work E-mail
Work E-mail
13
. How do you usually get to work?
How do you usually get to work?
Walk
Bus
Train
Drive Alone
Carpool
Vanpool
Other
14
. Will this be the first time you try an alternative commute?
Will this be the first time you try an alternative commute?
Yes
No
15
. How will you Dump the Pump during June 16-20, 2008?
How will you Dump the Pump during June 16-20, 2008?
Walk
Bus
Train
Vanpool
Carpool
Bike
Other
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