Help Make Our Streets Safer for Everyone
You can help to make our streets safer by telling us about your experiences and sharing your suggestions - created by Get Women Cycling
Email address
Age Group
Gender
How long have you been driving a vehicle?
What type of vehicle do you drive
Required
Do you drive for a living?
Required
Have you are suffered or witnessed a crash?
Have you or a loved one been involved in a crash?
Do you have an opinion of our mayor's Vision Zero policies?
Which mode(s) of transportation do you mostly use for your daily commutes?
Required
On average how many miles are your commutes?
What can you do when you drive cars do to improve traffic flow and reduce crashes? (Select as many boxes as you like)
Required
What can people who ride bicycles and walk do to improve traffic flow and reduce crashes? (Select as many boxes as you like)
Required
Do you know how to ride a bicycle?
Do you think of Citi Bike should be in every neighborhood in NYC?
When was the last time you rode a bicycle?
Your answer
Would you like to more information on:
If yes, please provide your name, phone number or email and zip code:
Your answer
Miscellaneous
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms