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  1. Please complete this form to register if you are regularly using an alternative way to and from work. Submitting this form allows the City of Bothell’s Employee Transportation Coordinator (ETC) to create a account for you. You will use the account to track your alternative commute trips and participate in reward programs. For each month you meet the threshold of 60-89% of alternative commute trips, you will receive $20 in the form of a MasterCard® credit. A $30 credit is given in the months in which your alternative commute trips are 90% or above. Additional incentive programs are available through or you can contact your ETC. To receive rewards, you must submit this completed form to the ETC, and you must have all of your alternative commute trips recorded on the calendar. Alternative trip logs must be updated by the 5th day of the following month (i.e. by March 5th for February commute trips). It is the Employee’s responsibility to submit a revised form when work or personal addresses change. The employee needs to notify the ETC in writing if they no longer use an alternative way to work. The ETC may at any time request updates to this form or accounts. It is the employee’s responsibility to report a lost or stolen MasterCard®. The employee is responsible for the replacement fee for the card.
  2. Questions about this form or the program can be submitted to the Employee Transportation Coordinator at
  3. Employee Contact Information
  4. City Facility You Work at:*
  5. Your Home Address and Commuting Information
  6. Modes of Transportation you Use*
    Which method(s) are you using as an alternate to a Single Occupancy Vehicle (SOV)?
  7. CTR Policy Employee Agreement*
    I certify that I will utilize the above mode(s) of transportation as stated above. Should any changes occur in my participation program, I will immediately notify the City of Bothell’s ETC. I understand that I am eligible for the Commute Trip Program MasterCard incentive as long as I use an alternative way to and from work at least 60% of the days worked in a month (an average of three days worked per week) and report those hours by the 5th day of the following month in the tool. I have read the policies and procedures for participation in the City’s Employee CTR Program and agree to the terms. I understand the ETC may verify this information at any time.
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  9. This field is not part of the form submission.