Car Free

Registration Form

Please fill out form completely.

All items with an * are required.

If you have any questions concerning this form, contact KMM using the contact page.
How did you hear of this program being offered by KMM?:*
I was referred by   
Website   
Radio
Newspaper   
KMM Newsletter
My Employer
KMM email blast
Social Media
Other   
My Contact Information
First name:*
Last name:*
Address:*
City:*
State:*
Zip code:*
Phone:*
Email:*
Employer's address:*
Please indicate how you will choose to go Car Free.*
Take a train or bus
Ride a bike
Walk to lunch
Bring a brown bag to lunch
Work from home
Carpool or vanpool
Other   
Verification
Please read and check:*
By checking this box, I verify that I will go Car Free or Car Lite at least once during the week of Sept 20th to Sept 26th.