Trip Reduction Program Registration

Trip Reduction Program Registration

I was an Alternative Mode User (AMU) last month and want to register for the:

$20 monthly prize drawing $10 quarterly raffle for new participants

Guaranteed/emergency ride home Carpool parking spaces

Access to showers/lockers

Name: ________________________________ Month: ________________________

Contact Information: _____________________________________________________

_____________________________________________________

First-time participant? Yes No

License plate # (needed if you use the carpool parking spaces):_____________________

I used the following (circle those that apply):

Carpool Bike Walk Bus

Please check off which days you used an alternative mode in the month in the calendar:

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For Office Use:

Transportation Coordinator: Keep all registration forms on file for at least 12 months. Have your employees sign/date below if they were awarded a prize and/or received a subsidy. Staple the prize receipt or proof of subsidy payment to this form before filing.

Employee signature for prize/subsidy payment ____________________________ Date _______________