Group Services Affiliation

Group welcome pack

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Register

You need to login or register first before completing this form.

Contact name

Name and address to which invoices should be sent. (if different from above)

Names and addresses of organisation members or individuals authorised to make bookings.

Annual User Registration (please tick one of the following boxes):

Pro rata charge apply for mid year affiliations.

Status
(Please answer all questions)
Are you a group/individual listed below:

Our vehicles may only be used by groups involved in one or more of the activities listed below.
(Please tick those with which your group is concerned)

Please read and sign the following declaration: The above organisation agrees to abide by the terms and conditions as set out in the Merton Community Transport vehicle user agreement and the affiliation pack. We understand that any breach of these conditions may result in our group being removed from MCT’s affiliation user list. All information supplied is correct, and I am authorised to make this commitment on behalf of the above organisation.

Having completed this form, including the monitoring details, please return it with a cheque for the appropriate amount made payable to: Merton Community Transport.

Merton Community Transport is committed to the promotion of equality of opportunity in the provision of its services. In order to ensure that all affiliated sections of the community benefit from these services, we would be grateful if you could provide us with the following details regarding you as an individual /organisation and its members and users of MCT services. Should you require any assistance with the completion of this form, please phone MCT’s offices on 020 8648 7727.

Please give an estimate of the numbers of your members in each category listed below!

Ethnicity:

Age Range:

Others:

How many of your members or individuals who will benefit from MCT’s services live in the following areas: (please use map below for guide)

This affiliation will not be processed until the payment for this application has been received.
Payment can be made by cash or cheque. Please make cheques payable to Merton Community Transport. We cannot process credit or debit cards.