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Name: |
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Email Address: |
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Home Information |
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Address: |
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City: |
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State: |
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Zip Code: |
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Home or Mobile
Phone Number: |
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Employment Information |
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Employer: |
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Work Address: |
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Work City, State,
Zip: |
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Work Phone: |
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Commute Information |
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Arrive at Work: |
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Depart Work: |
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Do you have any flexibility with
your arrival/departure times? |
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How
many days do you commute each week? |
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How many days/week would you like to carpool? |
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If
carpooling, would you prefer to? (Please check all that
apply) |
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Ride
Driver
Sharer
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If indicated RIDE only but you have a car, and we
found you a match, would you be willing to drive if
your match does not have a car? |
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Write your own
Carpool Classified:
Example:
“Looking to carpool from Bristol. Currently drive Rte 116 to
Williston Rd. Work hours: varied days, 9am – 5pm.”
or
“Looking to RIDE only from Cambridge. I work M-F from 7am – 3pm,
some flexibility. Non-Smoker preferred.” |
Referred by:
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Terms of Agreement for Cycle
Commuter Health Club Subsidy (Please check each box on the left below) |
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I
request to participate in the Seaport TMA's Carpool
Program. |
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I
hereby release the Seaport TMA and all service
providers from any liability, claims and demands for
personal injury, loss, theft or damages to my personal
property, loss of income, consequential damages
resulting from delays or absence of service provider,
or termination of the program. I also understand that
the Seaport TMA has the right to discontinue
participant privileges at any time. |
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I
understand that the Seaport TMA will require me to
complete a monthly report for the Program and that I
will not receive any prizes
until the report has been received. |
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Furthermore, I understand that incorrect use of this
program may result in
restriction from participating in the program. |
