Try Transit Incentive
Congratulations on taking the first step to try transit. By completing this application you are pledging to try transit as an alternative to driving alone to/from work. This is a one-time offer to receive a pre-loaded clipper card. Any duplicate or falsely submitted applications will remove you from all 511 Contra Costa incentive programs. Have any questions? Please contact 511 Contra Costa at 510-210-5930 or email info@511contracosta.org
How many days a week do you plan to use public transit? *
How many days a week do you work? *
Contact Information
First Name *
Your answer
Last Name *
Your answer
Home Physical Address (no P.O. Boxes) *
Please remember to include your unit or apartment number.
Your answer
Home City *
Your answer
Home Zip *
Your answer
Daytime Phone *
Do not include extra characters (no dashes or parentheses)
Your answer
Email *
We'll use this email to contact you with any questions about your application.
Your answer
Employer Information
This information is needed to verify your commute to/from work.
Employer Name *
Your answer
Work Location City *
Your answer
Work Zip *
Your answer
How did you hear about the Try Transit Program? *
Required
Acknowledgement & Agreement
I verify the information submitted is correct. I agree to complete a brief questionnaire following my participation in this program. *
Required
RELEASE & WAIVER OF LIABILITY
I recognize that participation in this Program is strictly voluntary and that such participation is not within the course and scope of my employment. I request to register my participation in this Program. I hereby assume full responsibility for all risk of injury and loss, including death, which may result from my participation in the program. I agree to hold harmless, release, waive, forever discharge, and covenant not to bring suit or claim against 511 Contra Costa, West Contra Costa Transportation Advisory Committee (WCCTAC), or their respective officers, agents, and/or employees from any and all claims and demands which I may have against 511 Contra Costa, WCCTAC, the Company, or their officers, agents, or employees, by reason of an accident, illness, injury, or death, or damage to or loss of or destruction of any property arising during such participation, or any time subsequent thereto, whether or not such loss, injury, or death is caused or alleged to be caused in whole or in part by the negligent acts or omissions of 511 Contra Costa, WCCTAC, the Company, or their officers, agents, or employees. The terms of this release are binding on my heirs, executors, administrators, and for all of my family members as well as myself. I have read the foregoing paragraph and fully understand the terms contained therein and submit this waiver freely and without inducement. *
Required
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