Join Us

To Become a Member you need to pay a small donation fee of £10 per year.

This is a contact form to apply to be a member of Newtown Dial A Ride.

When you have filled out the from please click the submit button near the bottom of the page.

Your Name (required)

Address

Postcode

Date of Birth (required)

Next Of Kin

Contact Number

Date

Please tick the ones that apply to you
 I'm a pensioner I am disabled I am in a wheelchair I can be transferred

For your well-being, please list any medical information that you feel that we need to know, or any additional comments we should know about, this will insure your journey is as comfortable as possible

Please make sure you have read all the information at the top of the page before clicking submit

If you would prefer to hand the form into our office please fill out all the required fields, print it and hand it into our office. Visit the contact us page if you would like to see the location off our office.