HPA Daily Entry Form

 

Here's how it works - fill out this coupon on each workday there is a High Pollution Advisory (HPA).

 

Only coupons submitted for a valid HPA day will be considered in the drawing at the end of each month and duplicate coupons will be discarded.

 

There will be drawings at the end of each month.  Winners will be announced by the 10th of the month following a drawing.  This contest is only open to current non-university State employees working in Maricopa County.

For which official HPA day are you entering? 

Please enter the date here   
   
Please tell us your:  
Name:   
Agency:

  
Work Address:  
Email Address:  
Phone #:  
   
Mode of Travel Used: (only choose one)
Transit: AFV, Hybrid:
Carpool: Bicycle:
Telework, Virtual Office: Vanpool:
Compressed Work Week Day Off Walk
       

Additional Comments: If more space is needed use our Feedback Form

 

Press "Submit" once, then wait a moment for confirmation of receipt

 

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