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Bike to Work Week 2010 Pledge Form
2.
Please fill out the questions below.
I pledge to ride my bike at least once during the week of May 17 - 21.
*
1.
Full Name
(Required.)
*
2.
Home Address
(Required.)
*
3.
City
(Required.)
*
4.
Zip
(Required.)
*
5.
E-mail
(Required.)
6.
Home Phone
*
7.
Employer (worksite, school) Name:
(Required.)
8.
Employer Address
*
9.
City
(Required.)
*
10.
Zip
(Required.)
11.
Round Trip Commute Miles:
12.
How do you usually get to work?
Walk
Bus
Train
Drive Alone
Carpool
Vanpool
Other
13.
Will this be your first bicycle commute?
Yes
No
14.
Will you connect to a bus or train on your bike trip to work?
Yes
No
15.
Which Day(s) will you ride your bike?
Monday
Tuesday
Wednesday
Thursday
Friday
All Week
