Individual membership form WCT will only use the information supplied to administer your membership and to keep you informed of our services. WCT will not pass your details to any third party and you can request that your details be permanently erased at any time. By signing this declaration you agree to this use of your data - see our Privacy Statement for full details.Please tick which membership applies to you: Road Runner Membership is for people who find it difficult to use public transport and who need our Door-to-door Service. We use accessible minibuses and can accommodate wheelchairs and mobility aids. Services include the shopping shuttle, shopmobility and outings. We can provide wheelchairs, scooters and volunteers to help. Silver Day-Trippers Membership is for people over 60 who can use public transport. We use normal minibuses and run outings throughout the year, picking up from bus stops across the borough. Roehampton Transport Club (RTC) is an additional membership option for people in Roehampton who have difficulty accessing public transport and want to travel to designated local amenities. The service is available as part of the Council’s Alton Renewal Plan. You can choose to join the Roehampton Transport Club by itself, or also join as a Road Runner or Silver Day-Tripper member. Find out more about the Roehampton Transport ClubJoin the Roehampton Transport Club? I want to join the Roehampton Transport Club Full name(Required)TitleMr/Mrs/Miss/Ms/OtherAddress (including post code)(Required) Street Address Address Line 2 Town/City Postcode Email address (if you use one) Date of birthTelephone number(Required)Mobile phone numberContact details for family/friend/neighbourNameRelationship to youPhone numberEqual Opportunities Monitoring and Membership VerificationWandsworth Community Transport is fully committed to the promotion of equality both in the provision of its services and as an employer. In order to ensure that we are providing services as widely across the community as possible, we would be grateful if you could give us the following information, which will be held in the strictest confidence and will be used for statistical purposes only.How did you come to hear of the services provided by WCT? Age UK Council publicity Doctor's Surgery Internet Library Newspaper Publicity leaflet Saw a WCT bus Shopmobility Social Worker Word of mouth Other What is your gender? Male Female What is your ethnic origin? White Black/Caribbean Black/African Black other Indian Pakistani Bangladeshi Chinese Other Asian Mixed Other Support needsWhy do you find it difficult to use public transport?Do you need documents in large print? (sent “freepost for the blind”) Yes No Do you use any of these mobility aids?Please tick the one you use most often Manual wheelchair Electric wheelchair Frame Do you normally transfer to a seat on the bus? Yes No Do you wish to use the Shopping Shuttle which goes to Wandsworth Sainsbury’s? Yes No Do you normally have a friend or a relative who travels with you? If so, please give full details.Do you need us to find someone to help you when you go out? Yes No Do you need to borrow a wheelchair or scooter from Shopmobility? Yes No Declaration and Data Protection(Required) I wish to join Wandsworth Community Transport as a “Passenger Member” and I agree to abide by Wandsworth Community Transport’s Terms and Conditions, Passenger Membership (version 2024). WCT will only use the information supplied to administer your membership and to keep you informed of our services. WCT will not pass your details to any third party and you can request that your details be permanently erased at any time. By signing this declaration you agree to this use of your data – see our Privacy Statement for full details.PhoneThis field is for validation purposes and should be left unchanged.
