ShareLogo

Apply for Share-A-Ride 

Please fill in this application and we will mail you (either by snailmail or e-mail) a list of other commuters who have similar home and work locations and work hours. Only your name and contact phone will be given out to your potential car/vanpool partners. Contact is made only by phone, home addresses are never given out by us. 

Home Information: 
Name:
Mailing Address:  
City: State: AK Zip:
Nearest Main
Intersection:		    and 
Home Phone:   Fax:
Can others call you at home about car/vanpooling?  Yes  No

Work Information 

Employer:   
Work Address:   
City:    State: AK  Zip:   
Nearest Main
Intersection:		    and 
Work Phone: Fax: 
Can others call you at work about car/vanpooling?   Yes   No 

Personal Information 

When do you start and end work?  Start work:  AM PM   ||  End work: AM PM 
How do you want to use the 
car/vanpool?  		 Drive Only   Share Driving   Ride Only 
Do you want to be in a vanpool?   Yes   No 
Do you smoke?   Yes   No 
Do you listen to the radio 
while driving?  		 Yes   No 
Do you want information on 
bus service in your area?  		 Yes   No 
How did you find out about 
the Share-A-Ride program?  		 
How do you usually drive to work?   Drive Alone 
 Share ride with family member 
 Share ride with co-worker 
 Take the bus 
 Walk 
 Bicycle/Motorcycle 

Getting the Information 

Finally, how would you like this information sent to you? 
  Waste no paper:   E-mail  it to me!  
 I like having things on paper:   SnailMail  it to me! 
 I'm a completist:   Do both  ! 
My e-mail address is:  

Press   to process this information, or   to clear the form data.