Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Sustainable Travel support for individuals Question Title * 1. This information will be held by Bristol City Council to help deliver this project. The Privacy Notice for this project can be found at: https://travelwest.info/pages/privacy-policy/roadshow-team-privacy-policy Yes, I consent for my information to be used for this purpose OK Question Title * 2. Please click which offers you are interested in receiving Personalised route plan – bespoke to help you look at all your options by foot, bike, public transport Loan bike (city/hybrid) Loan bike (folding) Loan bike (Electric bike) Adult cycle training Accompanied ride Free bus tickets to try out a new route Electric Vehicle one-to-one discussion OK Question Title * 3. What else would encourage you to choose make walking, cycling and public transport for more of your everyday journeys? OK Question Title * 4. If you have requested a loan bike, please provide your height in feet and inches OK Question Title * 5. If you have requested cycle training, please provide an emergency contact name OK Question Title * 6. If you have requested cycle training, please provide an emergency contact telephone number OK Question Title * 7. First name OK Question Title * 8. Last name OK Question Title * 9. Email OK Question Title * 10. Contact number OK Question Title * 11. Address OK Question Title * 12. Post code OK Question Title * 13. Number of adults in the household (17+): OK Question Title * 14. Number of children in household OK Question Title * 15. Number of bikes in the household OK Question Title * 16. Number of cars in the household OK Question Title * 17. How many people hold a licence in your household OK Question Title * 18. Normally, how often do you travel by the following types of transport? (Please exclude half term and bank holiday weeks) 6-7 days per week 4-5 days per week 2 to 3 days per week Once a week Once a month Less frequent/ Never Walk Walk 6-7 days per week Walk 4-5 days per week Walk 2 to 3 days per week Walk Once a week Walk Once a month Walk Less frequent/ Never Cycle Cycle 6-7 days per week Cycle 4-5 days per week Cycle 2 to 3 days per week Cycle Once a week Cycle Once a month Cycle Less frequent/ Never Bus Bus 6-7 days per week Bus 4-5 days per week Bus 2 to 3 days per week Bus Once a week Bus Once a month Bus Less frequent/ Never Motorcycle or scooter Motorcycle or scooter 6-7 days per week Motorcycle or scooter 4-5 days per week Motorcycle or scooter 2 to 3 days per week Motorcycle or scooter Once a week Motorcycle or scooter Once a month Motorcycle or scooter Less frequent/ Never Train Train 6-7 days per week Train 4-5 days per week Train 2 to 3 days per week Train Once a week Train Once a month Train Less frequent/ Never Car driver (alone) Car driver (alone) 6-7 days per week Car driver (alone) 4-5 days per week Car driver (alone) 2 to 3 days per week Car driver (alone) Once a week Car driver (alone) Once a month Car driver (alone) Less frequent/ Never Car driver (with others) Car driver (with others) 6-7 days per week Car driver (with others) 4-5 days per week Car driver (with others) 2 to 3 days per week Car driver (with others) Once a week Car driver (with others) Once a month Car driver (with others) Less frequent/ Never Car passenger Car passenger 6-7 days per week Car passenger 4-5 days per week Car passenger 2 to 3 days per week Car passenger Once a week Car passenger Once a month Car passenger Less frequent/ Never Other Other 6-7 days per week Other 4-5 days per week Other 2 to 3 days per week Other Once a week Other Once a month Other Less frequent/ Never OK Question Title * 19. How do you normally travel to the following places? Work Education Shopping/Erands Health (e.g. Doctor) Leisure Walk Walk Work Walk Education Walk Shopping/Erands Walk Health (e.g. Doctor) Walk Leisure Cycle Cycle Work Cycle Education Cycle Shopping/Erands Cycle Health (e.g. Doctor) Cycle Leisure Bus Bus Work Bus Education Bus Shopping/Erands Bus Health (e.g. Doctor) Bus Leisure Motorcycle or scooter Motorcycle or scooter Work Motorcycle or scooter Education Motorcycle or scooter Shopping/Erands Motorcycle or scooter Health (e.g. Doctor) Motorcycle or scooter Leisure Train Train Work Train Education Train Shopping/Erands Train Health (e.g. Doctor) Train Leisure Car driver (alone) Car driver (alone) Work Car driver (alone) Education Car driver (alone) Shopping/Erands Car driver (alone) Health (e.g. Doctor) Car driver (alone) Leisure Car driver (with others) Car driver (with others) Work Car driver (with others) Education Car driver (with others) Shopping/Erands Car driver (with others) Health (e.g. Doctor) Car driver (with others) Leisure Car passenger Car passenger Work Car passenger Education Car passenger Shopping/Erands Car passenger Health (e.g. Doctor) Car passenger Leisure Other Other Work Other Education Other Shopping/Erands Other Health (e.g. Doctor) Other Leisure OK Question Title * 20. Who is your local authority? Bristol City Council Bath & NE Somerset Council South Gloucestershire Council North Somerset Council OK Question Title * 21. If you are completing this form at a Travelwest event, please enter the event name now. If not, please leave blank. OK DONE