Join YourCar today!

Join YourCar in Leeds 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 *

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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 Ye 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.