Shrewsbury Shuttle Passenger Registration

Title*

First name*

Surname*

Forename(s)*

Telephone*

Email

Please check any of the following aids that you may use

Crutches or walking stick

Assistance Dog

Electric Wheelchair

Folding Wheelchair

Need to use lift

Manual Wheelchair

Mobility Scooter

Shopping Trolley

White Stick

Zimmer frame / Rollator

Do you have a bus pass? Yes No

Bus pass number*

Expiry date (DD/MM/YYYY)*

Please select the service you require:*

Please select your preferred pickup bus stop:*

Please Review Our Privacy Policy.

I confirm that I have read the privacy policy found here and agree to have my data processed by Shrewsbury Community Transport Initiative Ltd.

Agreed*

Shuttle Service Registration