I have read the Lifeline Mobility Program information, filled out the W9, and I agree to complete the mandatory training that includes signing up to use the e-voucher system.

I understand that BRAG is not responsible to reimburse trips that do not meet the program guidelines or if fraud is expected. I agree to reimburse BRAG, in the event automatic payment is distributed in error or for a trip found to be ineligible. I understand that failure to do so will result in my removal from the program and may result in legal action.

Although BRAG encourages all drivers to have a valid license, vehicle registration, adequate insurance, and to only provide transportation for trusted individuals; I understand I am liable for the transportation I provide.

I verify the information I have provided on this form and the W9 is accurate to the best of my knowledge. I agree to update BRAG with any changes to this information and provide accurate information when submitting vouchers. I understand failure to do so may result in being removed from the program or legal action.