Try Transit Application Form

Full Name *

First Name Last Name

Offer: Choose Your Way Bellevue wants to remind you that you can travel by transit or vanpool during and after the pandemic, and help you get back to doing so safely. Our Stay Healthy Kits promote safe and healthy transportation, each one containing an adjustable cloth face mask, hand sanitizer, sanitizing wipes and printed information about using transit, vanpool during COVID, all within a durable, reusable zippered pouch! There are two information types: transit and vanpool please indicate your preference below. After we receive your request, we will send one kit to your mailing address.

Learn more about healthy transit riding and vanpooling.

Eligibility:

Must live or work in Bellevue.
Limit one per person and one per email address.
For more details contact us at info@cywb.org .

Please Select ONE: *

Stay Healthy Kit - TRANSIT Stay Healthy Kit - VANPOOL

Home/ Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email

example@example.com

How did you hear about the Stay Healthy Kits? *

Choose Your Way Bellevue Newsletter Choose Your Way Bellevue Social Media (Twitter, Facebook, Instagram) Choose Your Way Bellevue Website or Blog Choose Your Way Bellevue Mailer

Terms and Conditions *

I understand this is a first come, first serve basis and I may not receive a kit if supplies runs out. I understand that if the kit is returned to Choose Your Way Bellevue in the mail and Choose Your Way Bellevue is unable to reach you to receive a working mailing address within six weeks, this offer will be forfeited.

Stay Healthy Kit Application Form