Secure Your Cycle Application
Thank you for your interest in our Secure Your Cycle Program! This program is designed to provide a safe way to lock up your bicycle for Contra Costa commuters.

By completing this application you are pledging to cycle more, as an alternative to driving alone to/from work. This is a one-time offer to receive a pre-loaded $20 BikeLink card, that can be used at BikeLink lockers all over the Bay Area

If you have participated in any 511 Contra Costa incentive program during the promotion period, you are not eligible for this offer. 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 creilly@511contracosta.org
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How many days a week do you work? *
Do you own or have access to a vehicle on a regular basis for your personal use? *
Do you have a valid driver's license? *
To be eligible for the Secure Your Cycle program, participants must currently commute by driving alone and be interested in replacing some of your car trips with bicycle trips or currently drive or be driven to transit or a carpool/vanpool pick up. How do you currently get to work on a typical day? (Please choose the one that best describes your normal commute) *
How many days a week do you plan to bicycle? *
Contact Information
Your $20 BikeLink card will be mailed to the home address you provide. We will communicate with you via email if we have any questions or need any additional information
First Name *
Last Name *
Home Physical Address (no P.O. Boxes) *
Please remember to include your unit or apartment number. Funding limits us to one (1) transit incentive per household, per fiscal year.
Home City *
Home Zip *
Daytime Phone *
Do not include extra characters (no dashes or parentheses)
Email *
We'll use this email to contact you with any questions about your application.
Employer Information
We may contact your employer to verify your commute to/from work
Employer Name (Name of company, organization, etc) *
Work Location City *
Work Zip *
How did you hear about the Secure Your Cycle 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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