Becoming a Worcester Wheels Member allows you to book your trips and attend our yearly Events. Our Membership fee is £10.00 and it will be charged over the phone. Please fill in the form below and we will contact you as soon as possible to complete your registration.Please enable JavaScript in your browser to complete this form.Salutation: *Please selectMrMrsMissMsMasterCllrRevDrDhoName *FirstLastAddress: House/Flat Number and Street: *Address: Post Code, City/Town: *Telephone Number: *Mobile Phone:Email:EmailConfirm EmailDate of Birth *Contact Details in Case of Emergency: *FirstLastEmergency Telephone Number: *Relationship to You: *Tell us about your Mobility/Disabilities/Illnesses (Please read carefully): *Manual Wheelchair UserElectric Wheelchair UserCAN transfer from wheelchair to the seatMobility ScooterCannot Climb steps/ CurbsNeed Tail Lift to Access the VehicleDementia/AlzheimerFrailVisual ImpairmentsBlindHearing ImpairmentsDeafNeed to be Accompanied by a relative/carer/friendWalking Aids (Please specify the type in the section below)Breathing ConditionTravel with OXYGEN CylinderPoor BalanceABLE to walk short DistancesBrain InjuryParkinsonEpilepsyLearning DisabilitiesDiabetesPoor Mental HealthNo health and Mobility problems* If you selected any of the above, Please specify so we can meet your needs: *Are you able to get in and out of a car? *YESNONeed HelpAre you able to climb few steps on and off a bus? *YESNONeed helpAny other information you think might help us meet your needs? (I.e travel with a guide dog, seat belt exeption etc):Have you got a BUS PASS? *YESNOYour BUSS PASS NUMBER AND EXPIRY DATE (Please include to get the transport at the discounted rate):GDPR Agreement *I consent to having Worcester Wheels securely store my submitted information so they can respond to my inquiries.Submit