Go Chapel Hill Birthday Club - Driving Less & Feeling Great!

Birthday Club 2023 -2024! Make sure to sign up for your gift!

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* 1. **In the last 12 months, I've used the following commute modes, (telework included) - Check all that apply.**

	2 - 5 days	10 - 12 days	Twice Monthly	Most All Work Days
Bicycle	Bicycle 2 - 5 days	Bicycle 10 - 12 days	Bicycle Twice Monthly	Bicycle Most All Work Days
Carpool	Carpool 2 - 5 days	Carpool 10 - 12 days	Carpool Twice Monthly	Carpool Most All Work Days
Park & Ride with Transit	Park & Ride with Transit 2 - 5 days	Park & Ride with Transit 10 - 12 days	Park & Ride with Transit Twice Monthly	Park & Ride with Transit Most All Work Days
Telework	Telework 2 - 5 days	Telework 10 - 12 days	Telework Twice Monthly	Telework Most All Work Days
Transit	Transit 2 - 5 days	Transit 10 - 12 days	Transit Twice Monthly	Transit Most All Work Days
Vanpool	Vanpool 2 - 5 days	Vanpool 10 - 12 days	Vanpool Twice Monthly	Vanpool Most All Work Days
Walk	Walk 2 - 5 days	Walk 10 - 12 days	Walk Twice Monthly	Walk Most All Work Days
Drive Alone	Drive Alone 2 - 5 days	Drive Alone 10 - 12 days	Drive Alone Twice Monthly	Drive Alone Most All Work Days

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* 2. Number of miles from my home to the building at which I normally work.

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* 3. Name of Workplace

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* 4. I know about the Emergency Ride Home program in case I need a taxi ride home for an emergency.
Register here in case a free taxi ride home is ever needed!!

Yes

No

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* 5. I believe that driving less, helps in keeping the air and water cleaner.

Yes

No

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* 6. Difference Maker: I believe I am making a difference when I join others in these efforts. I believe that every mile not-driven, makes a positive difference to our carbon footprint!

Yes, I'm a Difference Maker!

Thinking about it.

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* 7. Earn Points: Earning points for gift card drawings by tracking my commute trips sounds great! I will join the fun by registering today at the following link!

To Register-- After Opening This Link Click The Green Button On The Top Right.

Registered, thanks!

No thanks, not now.

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* 8. I am interested in assisting others if they need someone to ride a bicycle, walk or bus to work with, a couple of times, for the Go Buddy Commute program or for the Vets On The Move program!
Name & Email:

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

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* 10. YES! Please send my Happy Birthday Item!

Name

Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address