Guaranteed Ride Home Program Registration

If you are an employee of a participating North Shore TMA member,
you can register in the Guaranteed Ride Home program below.

STEP 1: Read the Program and Policy section.

STEP 2: REGISTER ONLINE
To complete your registration online, fill out then Online Registration Form below. You must read and agree to the “Terms and Conditions for Employee Participation and Release of Liability” in order to complete your registration.

To register by fax or mail, print out and complete the Registration Form AND Terms and Conditions. Return both forms to the North Shore TMA by mail or fax.

You must register with the North Shore TMA prior to using the program. Once the North Shore TMA has received and processed the completed registration forms, an orientation package will be sent to you with a voucher, program identification card, and program information. Please note that registration may take up to three weeks.

* Please include any mail codes used at your worksite! Program materials are sent via US Mail to your work address only.

NOTES:

Be sure to read the program and policy section carefully for information on qualifying uses and limits.
The Confirmation Report, which must be filled out following any use of the program, is available here.
To make changes to your addresses or other information, please email the NSTMA. Always be sure to provide us with a full and accurate work mailing address so that we can send program materials to you.

Online Registration Form

Personal Information	Work Information
Date:	Employer:
Name:	Supervisor:
	Begin work at:	(specify AM or PM)
	Leave work at:	(specify AM or PM)
Home Address:	Work Address*:
City:	City:
State:	State:
Zip Code:	Zip Code:
Home Phone:	Work Phone:

Email:

* Please include any mail codes used at your worksite!
Taxi vouchers and program materials are sent via US Mail to your work address only.

Commuting Information

My primary method of commuting to work is
(check as many as apply):

Bus
Subway
Commuter Train
Carpool
Vanpool

Shuttle
Walk
Bicycle
Other

If other, please describe:

Please identify train, subway or bus route(s):

Please identify fellow carpoolers/vanpoolers by name and phone number:

Driver:

Driver number:

Rider:

Rider number:

Terms and Conditions for Employee Participation and Release of Liability

By submitting this form, I request to participate in the North Shore Transportation Management Association's (NSTMA) Guaranteed Ride Home Program ("Program"). I have read and understand the policies, procedures, rules and regulation of the Program, and I agree to abide by them.

I understand that under the rules of the Program, transportation will be provided to me by a third party vendor, who is retained by the North Shore Transportation Management Association. I also understand that the NSTMA, Northeast Transit Planning & Management Corp, NSTMA member organizations and my employer are not responsible for the performance of the transportation vendor.

I hereby agree and state that I am an eligible employee of a member organization of the North Shore Transportation Management Association. I agree that if I use the Program in an unauthorized manner, I will promptly reimburse NSTMA for all damages resulting from the unauthorized use of the Program. I further agree to use my best judgment in participation in the Program and to faithfully adhere to all safety instructions and recommendations, whether oral or written. I hereby certify that I am a competent adult assuming these risks of my own free will, being under no compulsion or duress. I understand that my abuse of the Program may result in the loss of my eligibility to use its services in the future.

I, by requesting to participate in the Program, hereby assume full responsibility for all risk of injury or loss, including death, which may result from my participation in this Program and hereby agree to hold harmless, release, waive, forever discharge and covenant not to sue or bring claim against NSTMA, Northeast Transit Planning & Management Corp., NSTMA officers, agents, members and/or employees, and my employer, from any and all claims and demands whatsoever which the undersigned or any third person, and the representatives thereof have or may have against the said company, officers, agents or employees, by reason of any accident, illness, injury or death, or damage to or loss or destruction of any property arising or resulting directly or indirectly from my participation in the Program and occurring during said participation, or any time subsequent there to, 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 the company, their officers, agents or employees. The terms of this release shall serve as a release and assumption of risks for my heirs, executors, administrators and for all of my family members.

By checking this box you certify that you have read and agree to the "Terms and Conditions for Employee Participation and Release of Liability" statement above.

Please hit Submit now to send your information.

COMMUTER CHOICE

North Shore Transportation Management Association | 120 Washington Street, 3rd Floor | Salem, MA 01970
Andrea Leary, Executive Director | Al Marrone, Outreach Manager
P: 603-702-2156 | F: 781-639-6263 | Email NSTMA
Satellite office: 100 Cummings Center, Suite 342G, Beverly, MA 01915

The North Shore Transportation Management Association is a non‑profit organization,
working to address transportation issues in Beverly, Danvers, Lynn, Peabody and Salem.