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* 1. Number of days in the next 12 months that I will use these commute modes:

  5 days 12 days Daily Twice Monthly 1-3 days
Bicycle
Carpool
Park & Ride with Transit
Telework
Transit
Vanpool
Walk

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* 2. How many days did you use alternative transportation in the past 12 months:   

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* 3. Name of company, business, agency where I work:

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* 4. Roundtrip-- Total Number of Miles To & From Work:

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* 5. My E-Mail Is:

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* 6. Name (optional):

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* 7. Optional:  Please add my commute story, for promotions, to inspire others to try leaving their car at home (at least sometimes).

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