Dial-A-Ride Membership Registration
A Dial-A-Ride Membership card is required and is renewed annually on January 1st. The cost is $80.00.
Please make check or money order payable to "Senior Citizens Bus Committee".
Your Application and Remittance (check or money order) may be brought or mailed to the Dial-A-Ride Office, 299 Elm Street (Enfield Senior Center), Enfield, CT 06082. Please include a self-address stamped envelope if you want your ticket mailed to you.
Amount Enclosed $__________
_______________________________________ ZIP CODE_______________
Telephone No.___________________________ Date of Birth _____________
Wheelchair used: Yes____ No ____
Special Assistance required: Yes____ No ____
Signature__________________________________ Date __________________
EMERGENCY CONTACT PERSON:
Phone #'s Home ________________ Work ________________________