RappUnitedWay

Rappahannock United Way Logo

First Name

Last Name

Mobile Number

Address

Address 2

City

State

Zip

What is your Race?

What is your Ethnicity?

What is your Gender?

Are you a Veteran?

Are you 18 years of age or older?

Are you 55 or older?

Are you currently covered by any of the following health insurance?

Please select what type of appointment your ride is needed for:

Would you be willing to share your Ride United experience with Rappahannock United Way?

I am willing to comply with Lyft's Health Safety Requirements, which include wearing a face covering.

Do you already have a Lyft Account on your mobile device?

IMPORTANT NOTE: You must download and install the Lyft app BEFORE YOU GET YOUR FREE RIDE. If you do not have the Lyft app you can learn more here: http://www.lyft.com/rider/cities/fredericksburg-va