Guaranteed Ride Home Registration Form

If you are interested in registering for CDTC's GRH program, please complete the form below and mail it to CDTC or email it to questions@commuter-register.org  Click here for a PDF version of this form.

1. Please Provide Your Name, Phone # and Email Address (email address optional):

Name:________________________________________________________________________________________________

Phone #:_____________________________________________________________________________________________

Email:_______________________________________________________________________________________________  

2. Where Do You Live?

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

3. Where Do You Work?

________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

4. How Do You Usually Get To Work?
(“Usually” means 3 or more days a week):

q Drive Alone
q Non-CDTA Bus
q Carpool
q Carpool with Spouse or Room Mate
q Bicycle
q Walk

5. If You Take The Bus To Work, Which Bus Company and Route Do You Take?

Bus Company:__________________________________________________________________________________

Route #___________________________________________________________________________________________

6. If you Carpool to Work, Please Identify the Name, Home Location (Town)
and Telephone # of Each Person You Carpool With:

______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

Mail this form to: CDTC, GRH Program, 1 Park Place Main Floor, Albany NY 12205