Join as an individual....

Bristol Community Transport Membership

• Eligibility
  To apply for membership, you must be able to answer 'Yes' to the following questions:
• I live in Bristol and pay Council Tax to Bristol City Council *
  Yes
  
• I find it difficult or impossible to use conventional public transport *
  Yes
  
• Please note
  If you do not pay Council Tax to Bristol City Council but have a Bristol address, you may still be eligible to join some of our services - contact us for further details
• Personal details
• Title *
• First name *
• Last name *
• Address line one *
• Address line two
• Postcode *
• Telephone *
• Mobile
• Email
• Date of birth
  DD 01020304050607080910111213141516171819202122232425262728293031   MM 010203040506070809101112   YYYY 200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916
• Emergency contact name
• Emergency contact number
• Reasons for using the service
• Why do you need our door to door transport services? Please tick all that apply. *
  I use a mobility aid
  I find it difficult to climb steps
  I find it difficult to stand for any period of time
  I am partially sighted or blind
  I need to use a wheelchair
  I find walking difficult
  I find communication difficult
  I can only travel for a limited time on a vehicle
  Other reasons not listed
  
• If there were any other reasons not listed, please let us know
• Wheelchair & Mobility Aid Information
• Do you use a wheelchair or scooter when travelling? *
  No
  Manual wheelchair
  Electric wheelchair
  Electric scooter
  
• If you use a wheelchair or scooter, what is the make and model?
• If you use a wheelchair or scooter, you may need to transfer to a vehicle seat to travel for safety reasons - is this possible for you?
  Yes
  No
  
• Do you use a walking or mobility aid when travelling? Please tick all that apply. *
  No
  Walking frame
  Zimmer frame
  Shopping Trolley
  Oxygen
  Other aid
  
• If other, please specify
• Travel companion
  Bristol Community Transport may ask you to travel with a companion if your support needs are more than our Driver can provide to ensure your needs are met
• Do you need to travel with a companion to provide support? *
  Yes
  No
  
• Do you have a Travelcard (bus pass) *
  Yes
  No
  
• If yes, what is the Travelcard number
• If yes, what is the Travelcard expiry date
• Are there any other details about your travel needs you would like to share with us?
• I would like to register for annual membership of BCT as an individual and understand that my annual membership is £15. *
  I Agree
  
• Declaration *
  I understand that Bristol Community Transport reserves the right to request further information in support of my application and/or the right to refuse an application
• I confirm that the details provided in support of my application are correct *
  Yes
  

• Robot checking, you must tick the 'I am not a robot' box before submitting or saving your information.