Bicycle Incentive Program Signup

Application and Usage Agreement

Please complete and sign this Application and Usage agreement after you have read and understood the Bicycle Incentive Program Guidelines.

Applicant Name:



Work Address:

Preferred Phone:

Applicant’s mode of travel, prior to applying for the bicycle incentive (select all that apply):

Drive Alone







Total number of one-way commute miles?

Approximate number of bicycle trips per week?

Check One:

Participant already has a commute bicycle

Bicycle will be for a new bicycle commuter

Bicycle will replace an existing commute bicycle

Please Check:

During fair weather, I agree to commute by bicycle at least two (2) days per week.
I agree to register on the Sacramento Region Commuter Club,

Briefly explain why you are interested in purchasing a new bicycle:

Please check each box:

Applicant understands that the Commuter Bicycle Incentive Program shall terminate upon depletion of program funding or by a decision of Yolo TMA which shall be under no obligation to honor requests received following the depletion of program funding or termination of the program.

The applicant agrees to complete a Usage Survey every month for three months. Participant also agrees to become familiar with and follow California Vehicle Code Laws relating to bicyclists. In the event any of these terms are not met, the incentive shall be returned to the Yolo TMA.

The incentive check(s) will be given to applicant’s Employee Transportation Coordinator, who will provide the incentive to applicant. Applicant agrees to notify TMA of any workplace changes.

Applicant agrees to defend, indemnify and hold harmless Yolo TMA, its officers, agents, employees and volunteers from any and all losses, costs, damages, fines or expenses (including attorney fees, court costs and expert fees) or liability of any kind or character to any person or property arising from, or alleged to arise from, any breach of the responsibilities required of the participant by this Agreement or which are related in any way to the Commuter Bicycle Incentive Program or other incentives received. Commuter signature below verifies that they have read and understand, as well as agree to comply with, program policy, procedures and guidelines.

Name of Applicant:

Date of application: