Cotswold New Passenger Registration

Passenger Registration

Community transport is only available in the North Cotswold and Cirencester areas. If you are not sure if your area is covered please check the maps in the transport area of our website.

Please complete all fields marked with *

Your details

Title*

First name

Forename(s)*

Surname*

Address*

Post Code*

Telephone*

Mobile

Email

Date of birth (DD/MM/YYYY)*

Service Required*

Emergency contact

You must provide an Emergency Contact name and telephone number. This does not have to be someone living nearby and can be a relation, friend, neighbour, or carer.

Name*

Telephone*

Email

About You

Blue Badge

Do you have a Blue Badge? Yes No

Additional Information

Please enter here any additional information that you would like us to pass on to your driver, e.g. if your house is difficult to find.

Driver notes

Other Information (if applicable)

GDPR Consent

Cotswold Friends would like to stay in touch with you regarding our latest news and information, forthcoming events and campaigns. We will treat your information with respect. Would you give consent for Cotswold Friends to stay in touch? Are you happy to receive this by e-mail (if provided) and/or by post., and receive telephone calls?

I am happy for Cotswold Friends to contact me via:

Post Yes No

Email Yes No

Telephone Yes No

Marketing Consent Date

Please check this box to confirm your application*

Payment

The annual Membership fee is £24.00. There is no limit to the number of bookings you can make with us.

I wish to pay by

You have requested to pay your membership fee by bank transfer (BACS). Our bank details are:
Bank HSBC, Sort code 40-17-19, Account no 21498029

You have requested to pay your membership fee by cash. To do this, please visit our offices at Moreton Area Centre, High Street, Moreton in Marsh, GL56 0AZ weekdays between 9.30am and 3.30pm.

You have requested that we call you to take payment of your membership fee by debit/credit card. We will do our best to get back to you within one working day.

You have requested to pay your membership fee by debit/credit card. Please call us on 01608 651115 weekdays between 9.30am and 3.30pm for us to take payment.

You have requested to pay your membership fee via an on-line donation. Go to the Make a Donation section of our webste, www.cotswoldfriends.org.

You have requested to pay your membership fee by cheque. Please make this payable to Cotswold Friends and send it to Cotswold Friends, Moreton Area Centre, High Street, Moreton in Marsh, GL56 0AZ.

ReCaptcha

Thank You!

Your membership request has been submitted successfully. If you have requested a call back regarding membership payment we will do our best to get back to you within one working day. If you are paying by other methods, once the membership payment has been received we will send you a membership letter to confirm successful registration. This will be via email if you have provided one, or by post.