Test Page Emergency Ride Home Lyft Registration Do you have a valid Wiscmail or UW Health email address? Yes No Enter your Wiscmail or UW Health email address.(Required) Enter Email Confirm Email You will only be able to submit this form with a valid Wiscmail or UW Health email address.Name(Required) First Last What is your department, school, or college?(Required)What is your phone number?(Required)What is your work address?(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent(Required) I agree to these rules and restrictions of the Emergency Ride Home program:1. I am a UW-Madison or UW Health employee. 2. I will use the Emergency Ride Home (ERH) Lyft code for rides from work on days I did not drive to work alone. 3. I will only use the ERH Lyft code for rides due to a personal crisis that required me to leave work, such as an illness of myself or a family member. 4. I will not use my ERH Lyft code for driver gratuities. 5. I understand I may only take three (3) or fewer trips home in any six (6) month period. 6. I understand my ERH Lyft code will expire after six months and I must resubmit this form to get a new code.If you are a UW-Madison or UW Health employee without access to a wisc.edu or UW Health email address and would like to use the ERH program, please call customer service at (608) 263-6667 or email Commuter Solutions.NameThis field is for validation purposes and should be left unchanged.