Last Name* First* MI

Street Number   (No PO Boxes)

* Street Name*

Address Line 2 / Apt #

City* State* Zip*

Home Phone () - Cell Phone () - Do not give out cell phone number.

Closest Intersection or Cross Street

Mailing Address (if different     from home address)

Mailing Address Line 2 / Apt #

City State Zip

E-Mail Address
(Your e-mail address will speed delivery and save postage)

Employer or School Name* I am a student

Employer Street Number* Street Name*

Employer Address Line 2 / Building number / Suite number

City* State* Zip*

Work Phone( ) - ext.

How do you usually get to work or school?
Carpool Transit/Bus Bicycle Walk
Telework Vanpool Drive Alone Other

If or when you do not use your usual mode,
which other commute mode do you typically use?
Drive Alone Carpool Transit/Bus Bicycle
Walk Telework Vanpool Other

How did you hear about us?
Friend/Co-worker Website Event/Promotion
Highway Sign Newspaper/TV/Radio Phonebook
Brochure Employer Ad on Bus Other

I am enrolling in the Emergency Ride Home program
(if it is offered at my work site) and do not want a match list at this time.

How would you prefer to be contacted?
Email Home Address Work Address

Working Hours: 1 2 3 4 5 6 7 8 9 10 11 12 00 05 10 15 20 25 30 35 40 45 50 55 A.M. P.M.   to: 1 2 3 4 5 6 7 8 9 10 11 12 00 05 10 15 20 25 30 35 40 45 50 55 A.M. P.M.

Are your work hours flexible? YES NO
Start flex 0 15 30 45 60 minutes or more
End flex 0 15 30 45 60 minutes or more

Are you interested in information about a carpool or vanpool? Yes No

Would you prefer to be a . . . ?
Driver Rider Either

Comments to appear on your matchlist

Comments to the rideshare staff

    By submitting this application you agree that the information is accurate and that you agree to have this information entered into a regional rideshare database for the purpose of determining potential rideshare partners.  Matches are made via computer and based on proximity of home and worksite addresses and work schedules.  You will receive a letter or e-mail containing names and contact information of potential ridesharing partners.  Other commuters requesting matches will be provided your contact information, including your street name (but not house number), contact phone number and/or e-mail address (based on your stated preference). We don’t sell, rent, or lease customer data to third parties, and we don’t share your information with others, except (as noted above) on matchlists for commuters seeking potential rideshare partners.

   Participation in a carpool, vanpool or Emergency Ride Home (ERH) program is an individual decision.   Ridesharers are completely responsible for the operation of their carpools or participation in vanpools.  Cherriots Rideshare, Valley VanPool and the Salem Area Mass Transit District shall have no responsibility or liability for any claims, expenses, or damages resulting from any individual’s participation in a carpool, vanpool, or the ERH program.