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Emergency Ride Home Program
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If you qualify and would like to apply for the Emergency Ride Home service, complete and submit the following application form online. You may also print out and complete the application and fax it to (901) 222-9561 or mail it to the AQIB office.To find out if you qualify, please refer to the
Policies & Procedures
Nearest major cross street
Round trip miles to work
Please check if you work
What is your normal work schedule?
If you work another shift, tell us the hours?
Do you need riders?
Please refer to the
Emergency Ride Home Policies & Procedures
to find out if you are eligible for a cab or a rental car.
Employee Address 2
Is your rideshare a:
Express Bus Route
Enter route number
Choosing the Express Bus Route option will disable fellow riders fields below. Proceed to the "Additional comments/questions" area.
Name(s) of people with whom you regularly rideshare:
Current Driver's Name
Back-up Driver's Name
Rider 1 Name
Rider 2 Name
Rider 3 Name
I hearby attest that I share a ride to my worksite at least three (3) days a week or fifteen (15) days each month with the person or persons named above. I further attest that I have read the policies and procedures of the Emergency Ride Home service and agree to comply with those policies and procedures. I hearby release the Regional Transportation Authority, its officers, board of directors, agents and employees from all liability, claims, suits, demands or damages for personal injury, loss, theft or damage to my personal property; loss of income; or consequential damages resulting from delays or absence of cab or rental car; or termination of the program.
By checking this box, you confirm the above statement.
Shelby County Health Department, Air Quality Improvement Branch, 814 Jefferson, 4th Floor, Memphis, TN 38105
(901)222-9594 Fax (901)222-9561
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Vasco A. Smith, Jr. County Administration Building • (901) 222-2300
160 North Main Street Memphis TN 38103
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