car pooling survey

This information will be exchanged with people with similar travel patterns Only after you have given your permission.
Name:* Home/Work Phone No.:
E-mail:*
Journey Details
Where Do you Travel From (Home)?*
Where Do you Travel To (Work)?*
On average how many times a week do you make this journey?*
On average what time do you travel to work?*
On average what time do you travel From Work?*
How many people travel in the car with you?*
Adults: Children:
Traffic Reduction Measures
Would you be interested in a car-pooling scheme? (Please tick, multiple options possible)
Using your car
In another car
Sharing the driving (eg. 2 days weekly or week on/off basis)
Using a bus with quality bus lanes
 
* - Mandatory fields