Forsyth County Ride-Share Registration Application

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Email *

Forsyth County Department of Transportation

One-time registration Fee is $15.00

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Birthday Year 4 Digit Year ONLY and is required for data purposes only *

Is this Rider Email or other Contact? *

Rider's Email

Other Contact email

Required

Cell Phone Number (Riders MUST carry a mobile phone for safety) *

Emergency Contact Information

Please list two nearby and available contacts

Name, Relationship, Phone *

Ex: George Washington, 555-555-555, Son

Name, Relationship, Phone *

Ex: Gloria Smith, 555-555-555, Sister

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