Smart Trips Order Form

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Thank you for taking the time to sign up for SmartTrips. It's a fun, interactive way for you to reduce your drive-alone trips and increase the number of trips taken by walking, biking, transit, or carpooling. And the best part, it's FREE! I agree to be included in the monthly InMotion e.newsletter.

Email *

Name *

Street Address *

Please send me my free: (Up to two kits per household) *

Walking Kit

Biking Kit

PeaceHealth Rides BikeShare Kit

Family Adventure Kit

LTD Bus Kit

Required

Please send me a free gift: (indicate your top two choices) *

Water Bottle

LED Clip Light

Bike Phone Mount

First Choice

Second Choice

Count all the places you went last week, including your return home. For example, going to the store would be one trip, coming home would be a second trip. LAST WEEK, how many trips did you make to any of your destinations by:

Driving alone (or with kids)? (Fill in the number) *

Carpooling (with adults)? (fill in the number) *

Bus/EmX? (fill in the number) *

Bicycling? (fill in the number) *

Walking? (fill in the number) *

Other (motorcycle, skateboard, taxi/Uber/Lyft, etc.)? (Fill in the number) *

A copy of your responses will be emailed to the address you provided.

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