2019 GREEN YOUR COMMUTE CHALLENGE REGISTRATION Survey

Agency/School(Required.)

Thank you for registering for the 2019 Green Your Commute Challenge! To participate, please fill out the registration form below, which will also sign you up as a member with 511NY Rideshare . You will receive an email from 511NY Rideshare in the next 1-3 days confirming your registration with instructions on activating your account.

Visit 511nyr.org/green-your-commute for details on tracking your sustainable commute!

First Name(Required.)

Last Name(Required.)

Email Address(Required.)

Home Address(Required.)

Apt. # (if applicable)

Home City(Required.)

Home State(Required.)

Home Zip Code(Required.)

Phone Number

Match Preference

Match with anyone meeting my commute

Match only with those who work for my same employer/school

Not Interested in Ridematching

Carpool Preference

Ride or Drive

Drive only

Ride only

Not Interested in Carpooling

Transit Preference

Not interested in transit

Interested in transit, need an itinerary

Interested in transit, do not need an itinerary

Already ride transit, do not need an itinerary

Bicycling Preference

Not interested in bicycling

Interested in finding a “Bike Buddy” to ride with

Are you interested in being matched with others when an emergency occurs?

Include me in Match-Me-In-Emergencies as a driver

Include me in Match-Me-In-Emergencies as a passenger

Not interested

Would you like to receive our Air Quality Action Day notifications from Clean Air NY?"

Yes, I would like to learn more

No, I do not want to receive updates