Join YourCar

Join YourCar today!

To join YourCar, all you have to do is to complete this simple form. We will add your £1 membership fee onto your first booking. 

Your details

Title *

Please select Mr Mrs Ms Miss Dr Prof Revd

First name *

Last name *

Date of birth *

DD 01020304050607080910111213141516171819202122232425262728293031   MM 010203040506070809101112   YYYY 2012 2011 2010 2009 2008 2007 2006 200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916

Address *

Postcode *

Home telephone *

Daytime telephone (if different)

Mobile

E-mail address

Getting out and about

Please give us a few more details about yourself so we can provide you with the right level of service and confirm your eligibility for YourCar

Do you consider yourself to have a mobility difficulty and/or a disability? *

Please select Yes No

If yes, please specify

Do you have sight or hearing loss? *

Please select Yes No

If yes, please specify

Are you a wheelchair user? *

Please select Yes No

Do you currently have difficulty using or accessing public transport for all your transport needs? *

Please select Yes No

If yes, please specify

Declaration

I am applying to join the YourCar scheme and the information I have provided is correct to the best of my knowledge.

Please tick box to confirm *

Yes, I would like to join YourCar
No thanks


If you have completed this form on behalf of someone else

please provide your name

please indicate your relationship with the applicant

Are they under 16 years of age

Yes No

Subject to HCT Group's Privacy Policy, we will not disclose any personal details you provide on this form to a third party.