Breathalyzer Brunch Application Form

Thank you for your interest in participating in CDOT's Breathalyzer Brunch at Spanky's Roadhouse (1800 East Evans Ave, Denver, Colorado 80210) on Tuesday, Aug. 27 from 11 a.m.-2 p.m. Breathalyzers are a DUI-prevention tool, useful whenever and wherever you may be consuming alcohol. To apply, please complete the questions below. Remember — consuming any amount of alcohol can make you unfit to drive!

Confidentiality Notice:

CDOT is collecting the information below to select participants for the Breathalyzer Brunch. This information will never be shared publicly, or for marketing purposes.

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* 1. We will notify you if you've been chosen to brunch with us! Please provide your contact information below.

Full Name

Email Address

Phone Number

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* 2. Please provide your age:

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* 3. Please provide your gender:

Male

Female

Other

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* 4. Please provide your ethnicity:

White

Black or African American

Spanish, Hispanic or Latino

Asian, Asian Indian or Pacific Islander

American Indian or Alaskan Native

Other (please specify)

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* 5. When drinking alcohol, I typically consume:

1-2 drinks

2-3 drinks

3-4 drinks

4-5 drinks

5 or more drinks

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* 6. How often do you typically consume alcohol?

Rarely/Never

Once a month

Every other week

1-3 times per week

3-5 times per week

5 or more times per week

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* 7. What is your brunch beverage of choice?

Mimosa

Bloody Mary

Both

Neither

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* 8. Do you currently have a valid driver's license?

Yes

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* 9. Please read the following conditions in order to receive your free BACtrack breathalyzer, if chosen to participate in the Breathalyzer Brunch. Select Yes, I agree to these conditions below if you understand and accept the conditions.

I will not use the BACtrack app or BACtrack device to determine whether I should operate a motor vehicle or other heavy equipment. I will not use the BACtrack app or BACtrack device to determine whether my blood alcohol concentration (BAC) is below the legal limit for driving. I understand the information provided by the BACtrack app and BACtrack device will not be accepted as evidence in court. I understand it is never safe to drive after consuming any amount of alcohol and can be arrested for impaired driving if my driving ability is affected to even the slightest degree.

CDOT will offer FREE LYFT ride credit to and from the Breathalyzer Brunch. I agree i will not drive impaired following the Breathalyzer Brunch.

Yes, I agree to these conditions

No, I do not agree to these conditions