* 1. What is your name?

* 2. Are you a Western faculty, staff or student?

* 3. Western ID

* 4. Email

* 5. Date of your GREEN Commute - If you traveled in a GREEN mode more than one day, you will need to fill out this survey for each day. Every day you submit will earn you one entry into the drawing.

* 6. In what GREEN mode, did you travel to campus? If you used more than one mode on this date, please check all that apply.

* 7. How many miles did you travel in a GREEN mode on this date? Please round up to the nearest whole number.

* 8. We would like to share your name as a Western GREEN Commuter in the Staff and Student Newsletters. Do you give us permission to publish your name?