* 1. Name

* 2. Company

* 3. How did you commute to work during this past week?

  Bicycle Bus Car Combined bike & bus Walked N/A
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

* 4. Was this past week a typical week in terms of commuting to and from work?

* 5. How far is your commute to work, one way?

* 6. On average, how many miles did you ride your bike last week for commuting, errands, exercise, pleasure, etc...?

* 7. Would you characterize last week as a typical week in terms of how many miles you rode your bike? If no, do you typically ride MORE or LESS than the past week?

* 8. If you don't own a bike why not?

* 9. Part of this program will offer educational classes for cyclists. Which of the following topics interest you?

* 10. Based upon your work schedule, what is best time for a brown bag luncheon to happen? Is 11am-12pm good, or does 12pm-1pm work better?

11. If you do not currently commute via bike, or you commute via bike infrequently, what is stopping you from biking more frequently?

* 12. Did your company have a team for Bike-To-Work-Day, and if so did you participate?

13. Thank you for your participation. Please visit: www.communitycycles.org to learn more about your local bike coop, and if you have any additional comments please feel free to share them with us. Thanks again!

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