Name:  

E-mail address or Phone Number:  

Mailing Address (or starting point of your carpool):                                                       

County you live in:

 Buncombe     Henderson     Haywood     Madison     Transylvania

Employer and Work Address (or carpool destination):                                                          

[Note: If you do not enter a home or business mailing address, we will not be able to send you reimbursements for Emergency Ride Home claims.]

Number of people involved in the carpool (including yourself):  

Names of people in your carpool:                                                                                                      

How many days per week does your carpool run?  

How did you hear about Share the Ride NC?  

Questions, Comments, or Concerns:                          

Please read agreement below before submitting registration:                     

By completing this form and clicking the Submit button, I am indicating that I understand and will adhere to the guidelines of the Clean Air Community Trust's Emergency Ride Home program and qualify by traveling to work at least one day per week by carpooling.  I hereby release the Clean Air Community Trust and the City of Asheville from any liability, claims, and demands for personal injury, loss, theft, or damage to my personal property; loss of income, consequential damage resulting from delays or absence of a taxi cab, or termination of the program.

I agree to waive any and all claims for personal injury, property damage, or negligence that I may have against Clean Air Community Trust, its officers, employees, or partners (City of Asheville). I also agree to hold harmless Clean Air Community Trust from any and all losses, claims, actions, costs, expenses and damages resulting from my participation in Share the Ride NC and to release Clean Air Community Trust from any associated liability.  By clicking the Submit button below, I certify that I have read and agree to these terms.

Thank you for carpooling!