New membership form – Disabled Ramblers

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Membership contact information

A red asterisk (*) means that a question is mandatory.

What is your title? *

Provide your title *

What is your preferred name? *

What is your first name? *

What is your last name? *

What is your preferred contact method? *

Email
Post

You can help Disabled Ramblers in saving postage costs by choosing the “Email” option.

What is your email? *

Confirm Email

What is the first part of your postcode? *

For example, AB12.

Which county is the postcode in? *

We use this information to understand where our members are located across the UK.

What is your address? *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Provide your county information in the “State/Province/Region” field.

What is your email? (optional)

Confirm Email

What is your contact number? *

We will use this information to contact you if we have issues when contacting you via your preferred method. A mobile phone is preferred if possible.

Are you planning to join our rambles? *

Yes
No
I don’t know yet

We have about six ramble programmes a year. Members can sign up to attend the rambles either by using their own mobility vehicles or a loan from Disable Ramblers. The availability of a loan is on a first-come-first-serve basis.

Will you rely on Disabled Ramblers' loan scooters? *

Yes
No
Sometimes

What kind of mobility vehicle do you have? (optional)

Heavy-duty-off-road scooter
Pavement scooter
Powerchair

Please follow this link to access our Scooter Information Document

What is the make of your mobility vehicle(s)? (optional)

What is the model of your mobility vehicle(s)? (optional)

Membership renewal payment information

How would you like to pay? *

Credit or debit card
Bank transfer
Cheque

You can help Disabled Ramblers by choosing the “Credit or debit card” option.

Annual membership subscription *

Price: £25.00

Additional donation Amount (optional)

Total

£0.00

Please enter your payment information: *

Disabled Rambler’s payment information by bank transfer

The annual membership subscription is £25.00

Business name: Disabled Ramblers

Account number: 02854088

Sort code: 30-98-37

This information is also available on the Disabled Rambler’s website.

Disabled Rambler’s payment information by cheque

The annual membership subscription is £25.00

Please make cheque payable to: Disabled Ramblers

Mailing address:
Attn: Judy Cunningham
34 Clunes Avenue
Nuneaton
Warwickshire
CV11 6AH

Increase the impact of your gifts

Boost your subscription and donations by 25p of Gift Aid for every £1 you donate, at no extra cost to you.

I understand that if I pay less income/capital gains tax than the amount of Gift Aid claimed on all my donations in the tax year in which they are received, it is my responsibility to pay any difference and that I must notify the charity of any changes to my tax status, including changes to my name or address.

Yes!

I am a UK Tax Payer and I would like the Disabled Ramblers to reclaim the tax on all qualifying donations I have made, as well as any future donations, until I notify them otherwise.

What is your title? *

(optional) Annual house?

Provide your title *

What is your name? *

First

Last

What is your postcode? *

What is your house number or the name of your house? *

Become a member of Disabled Ramblers

Membership contact information

Membership renewal payment information

Disabled Rambler’s payment information by bank transfer

Disabled Rambler’s payment information by cheque

Increase the impact of your gifts