Register

Register with our scheme

To confirm your eligibility for our schemes you will need to register your details. This can be carried out on line by clicking the link below or alternatively if you would prefer to register by telephone you should contact our coordinator on 01752 690444.

CONFIDENTIALITY – All of the information provided will be kept in the strictest confidence and will not be shared with any other parties.

By completing the on line form I agree to Ivybridge & District Community Transport Association holding the entered information on a secure computer system for the purposes of booking journeys and informing me of trips and events being organised for the benefit of Association Members.
Information will be retained for the period of your membership and updated every three years.

Please fill out the below form or download the Application Form here and post it back.

Registration Form

Title*
First Name*
Surname*
Address*
Town*
Parish*
Post Code
Telephone*
Mobile
Date Of Birth
Email address
Are you registered disabled?*
Are you a Blue Badge holder?*
Do you require an escort?*
Do you have any health problems?*
Do you use wheelchair or of the following mobility aids?*
- No
- Folding Wheelchair
- Rigid Manual Wheelchair
- Powered Wheelchair
- Shopping Trolley
- Taillift User
- Stroller
- Crutches
- Walking Stick
Seating Requirements*
Name of Kin*
Contact phone number (Next of Kin)*
Any other information
How did you hear about us?

A copy of your completed application form will be forwarded to your email address.