I pledge to seek other options of transportation as I go about my day on Wednesday, September 13, 2000. I will not drive my gasoline vehicle on this day. I will go to work or do my errands using an alternative mode of transportation.
Name

Date

Home address

Work address

Company name

Phone number to reach you

Email address, if available

Round trip # of miles to work/errand (estimate if necessary)

Type of vehicle you drive (check one): Car Truck

I will use one or more of the following instead: Walk Run Ride a bicycle Skateboard Rollerblade Ride the bus Telecommute Carpool (2 or more people) Ride the light rail Drive an alternative fueled vehicle Other

Note: This information will be used for tracking purposes and prize drawings only. Prizes will be drawn Sept. 13!

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