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Last
Name: |
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First Name: |
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Home Town/City: |
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During what
time frame do you want to arrive at your worksite in
the morning? |
(earliest arrival time) |
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(latest arrival time) |
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During what
time frame do you want to depart your worksite in
the afternoon? |
(earliest
departure time) |
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(latest
departure time) |
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How many days per
week (on average) are you interested in riding in
the vanpool: |
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Would you be
willing to share the driving? |
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Employer: |
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Work Phone: |
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Email Address: |
(Work
email preferred in order to verify employment with a
TMA member company) |
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Do you have a
preferred pick-up spot near your home (i.e. park
and ride lot, mall, supermarket, hotel, or other
location) that would be a reasonable meeting spot
for the van? Please list any ideas you have
in the space below. |
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Terms of Agreement for
Vanpool Program
Please put your initials in each text box to the left below.
You will
not be able to participate if you do not read and
initial each line. |
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I
request to participate in the Seaport TMA's Vanpool
Program. I have read, printed out and agree to
the terms outlined in the
document titled ASSUMPTION OF RISK, WAIVER OF
CLAIMS AND INDEMNITY AGREEMENT. |
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I
hereby release Seaport TMA 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 Seaport TMA may 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. |
