PLEASE NOTE: AT THIS TIME, THIS SURVEY IS INTENDED FOR KAISER PERMANENTE'S WORKFORCE ONLY. THANK YOU.

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* 1. I support Kaiser Permanente's effort to encourage active transportation, and I pledge to do my part to reduce my use of automobiles and fossil fuels by taking the following actions:

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* 2. How many one-way vehicle trips will I AVOID each week by walking, biking, or linking trips together where possible?

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* 3. How many single driver, one-way trips will I avoid each week by ADDING people to my trip (i.e. carpooling, vanpooling, shuttles, public transportation)?

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* 4. How many minutes will I walk or bike each week as a result of relying less on my automobile for trips?

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* 5. I will commit to taking the following steps to ADJUST my driving style in order to improve fuel efficiency in my car when I do drive:

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* 6. We'd like to stay in touch with you and track our campaign results.
Please provide your email address:

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* 7. Please indicate the part of the KP organization in which you work:

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* 8. Please indicate the facility in which you work so that your nearest KP Green Team can tally pledges:

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* 9. How were you referred to this website (if from an employee or department, please provide names)?

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