______Registration Buzzer Buses (Dial a Ride) Ltd.

Please fill in the application form on Can’t use a bus? the reverse of this page and include 31 New Road your subscription of £10.00. (Cheques Payable to: Buzzer Buses) Join Us This should be returned to us at: For just £10 Buzzer Buses (Dial a Ride) Ltd LU7 2LS 31 New Road Linslade Phone 01525 853566 Leighton Buzzard Email: [email protected] Bedfordshire www.buzzerbuses.co.uk LU7 2LS

Buzzer Buses is registered in We will send you a letter showing and Wales. your membership number which you should quote when booking. Company Registration No. 5338802

GDPR 2018 Charity Commission No. 1109107

The data collection on this form will Buzzer Buses only be used in connection with the VAT No. 916352234. service applied for and within our GDPR policy restrictions. Funded with the support of: Is your local Dial-A-Ride Policy available on request. Council. service, providing door to

Leighton Linslade Town Council door transport for

The Bedfordshire and Luton Community Leighton Buzzard, Foundation’s Luton Airport Ltd Fund. Linslade and surrounding villages. Version 2019 1 Door to Door and more Buzz the Buzzer on REGISTRATION FORM

Founded in 1991, Buzzer Buses Surname:…………………………………Mr/Mrs/Ms (affectionately known as ‘The Buzzer’) 01525 853 566 Forename:…………………………………………… provides a service for people who are Our booking line is open unable to use regular public transport Address:……………………………………………… or where no suitable service is Monday to Friday ……………………………………………………………… available. 10am to 4:00pm Postcode:…………………………………. Our buses are fully wheelchair Date of Birth:……………………………. Our buses run accessible. Phone No:…………………………………………… Our drivers can escort you to and from Monday to Friday Mobile No:…………………………………………. your door. 8:45am to 5:00pm Email:…………………………………………………. Disability details: Fares ……………………………………………………………… We cover When travelling with a Central Bedfordshire Travel Pass the ……………………………………………………………… Leighton Buzzard, Linslade, Heath & following fares apply. Please tick where relevant.. Reach, Billington, , Wheelchair User Manual/Electric * [ ] Stanbridge, , , Leighton Buzzard: £2.50 per trip. , , , Need companion/helper [ ] Ridgemont, Husbourne Crawley, Local Villages: £4-£5 per trip. Lack of public passenger services [ ] Woburn, . *Wheelchair assessment will be done before first journey. For journeys to Buckinghamshire Other Areas: Please call for fare. Emergency contact. Relative, neighbour please enquire. Name:…………………………………………………… Companions Phone No:…….……………………………………… Essential helpers, Guide Dogs and companions under 16 travel FREE. Mobile No: ……………………..…………………… Other adult companions pay the same price as the registered user. I declare that my incapacity prevents me from using ordinary buses, or there is a lack of an available local bus service.

Central Bedfordshire Travel Pass SIGNED:…………………………………… To qualify for a pass you must be a permanent Central Bedfordshire resident Date:…………………..…..…… and have reached state pension age or have a qualifying disability. See over for registration details.