CC Registration

If you've thought about ridesharing, but don't know how to get started, TRAFFIX can help. First, fill in the following questions, then submit them to TRAFFIX or call at 1-800-700-RIDE.

Name
Address
City, State, Zip
Home Phone
Work Phone
Email

I would be interested in the following rideshare programs:
Silverleaf Commuter Station
 Carpooling
HOV Express Bus Drive Only
Park-and-Ride Locations
 Ride Only
Silverleaf Commuter Station
 Vanpooling
Indian River Park-and-Ride
 Use My Van
Greenbrier Mall Park-and-Ride
 Ride Only
Lease a Van

The nearest intersection to which I live is:
1)
2)

The nearest intersection to which I work is:
1)
2)

Company Name or Command
Work Address
City, State, Zip
Start work
End work

Are your hours flexible within 15 minutes:
Yes No

I get to work now by:
Walk/Bike
 Drive Alone
Park-and-Ride
 Carpool
Vanpool
 Bus

Do you smoke?
Yes No

I heard about the TRAFFIX program mainly through:
Radio
 Newspaper
Road Sign
 Poster/Leaflet
Employer/School
 Friend
Phone Book
 TV
Web Site
 Other (Please Specify)

When a letter is sent out with names, addresses, and phone numbers of potential car or vanpoolers, would you like your home address to be included?
Yes No