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Commuter Registration Form for Carpoolers


Name:	

Address: Town: State: Zip:


Home Phone: Work Phone:

Rideshare partners should call: Home Phone Work Phone


Email:
Fax:
ORIGIN/PICK-UP ADDRESS

Address: Town: State: Zip:


DESTINATION

Place: Town: State: Zip:


ROUTE NUMBER TRAVELED (I.E. I-89 OR RTE. 120)

1. 2. 3.


I would like to: Ride Drive Share Driving: Occasional Use Regular Use Round Trip: Yes No
CARPOOL TIMES
CARPOOL DAYS:MONTUESWEDTHURSFRISATSUN
Time to leave home:
Time to get to work:
/
/
/
/
/
/
/
Time to leave work:

RIDESHARE PREFERENCES: Check all that apply.

Smoker Non-Smoker Male Female


SPECIAL CONDITIONS:
Need ride to meet you at home. Student under 16 Other

COMMENTS:

EXTRA CONTACT INFORMATION

Do you understand that the name and phone number you ok to share may be included in matchlists to other members, but will not be shown on the Rideboard? Yes

Please use the COMMENTS box above to tell us:

1.) Potential Carpool Partners can CONTACT me by E-MAIL.

2.) Potential Carpool Partners can see my E-MAIL address on the RIDEBOARD.

3.) Please add my FaceBook address to my RIDEBOARD "ad". The address is _____.

This online sign-up system will be phased out over the next few months as we move into our new Instant On-line Ride Matching website. To try out the new feature, please go to our front page and click on the link to set-up your new personal page and carpool matching details.  If you want us to place you in the new system, please let us know in the comments box above. Thank you! UV Rideshare


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