Membership No:

Your Contact Details

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In case of an emergency who should we contact?

Cambridgeshire County Council bus pass

If Yes:

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What is the main reason that you need to use this service? *

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When travelling with HACT, would you like to bring with you any of the following?

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Declaration *

I wish to apply for membership of Fenland Association for Community Transport and I agree to abide by the membership terms and conditions. I understand that any breach of these conditions may result in being expelled from membership.

This information will be held securely and will be accessed by employees of HACT for services you require. Your information will not be shared with any third parties and you have the right to request a copy of the information that we hold on you. Please tick box to confirm you have read the above statement and agree.