City of Madison Logo
Header: Rideshare

Rideshare Application

If you have any questions or would like more information please contact the Rideshare Etc. Program.

(* indicates required fields)

Commuter Name

First Name: *
Middle Initial:
Last Name: *

Home Address

(Home information will be kept confidential and will be used only for ride matching purposes.)
Address: *
Apt. #:
City: *
State:
Zip: *
Nearest Intersection: and

Contact Information

Two of three phone numbers required with area code *
Home Phone:
Cell Phone:
Work Phone:
Email Address:
I would like other commuters to contact me by (check all that apply):
    Cell Phone
    Work Phone
    Email

Employer/Work/School Destination Address

Company Name: *
Address: *
Suite/Department:
City: *
State:
Zip: *
Nearest Intersection: and

Mailing Address

(Please provide your mailing address if different from above. This includes post office boxes.)
Address:
Apt. #:
City:
State:
Zip:

Commuter Preference

Work/School Hours: * to
Are your work/school
times flexible?
Yes No
Minutes of flexibility: minutes variance in start time
minutes variance in end time

Match Preferences

Carpool Interest:
    Driver
    Rider
    Either
Vanpool Interest:
    Driver
    Rider
    Either
Bike Buddy Interest:
    Novice
    Experienced
    Either
I prefer to be matched with non-smokers
   Yes    No

I am interested in:

Carpool Yes No
Vanpool Yes No
Park and Ride Lot info Yes No
Transit Yes No
Bicycle Yes No
I have a vehicle Yes No