HOME INFORMATION:

Have you applied to PEDAL PALS before? yes no

WORK INFORMATION:

Company Name
Company Address Type Company Address
City State OH IN KY ZIP
Work Phone Number ( ) Ext.
Crossroad(s)
E-Mail

Reporting Time -choose time- 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 12:00 12:30 AM PM Leaving Time -choose time- 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 12:00 12:30 AM PM

How far would you be willing to travel before meeting someone? miles

Can you arrange more than a
     15-minute adjustment to your working hours? yes no

GENERAL INFORMATION:

How do you normally commute? Auto Van Bike Public Transit
Please indicate your gender -choose one- male female Match with same gender only?

CYCLING INFORMATION:

Please rate your cycling experience -choose one- novice experienced
I would like:
    To assist a novice cyclist
    An experienced cyclist to advise me on my commute
    A list of people to ride to work with

The purpose of this questionnaire is to obtain information for determining interest and developing potential commuter schedules for ridesharing. Completion of any or all of the items is purely voluntary and non-committal. Information provided will only be used in determining the feasibility of offering a service to interested individuals. Contacting potential Pedal Pal cyclists to ride with is solely the responsibility of the applicant.