To help us select a driver and the car that would suit you best, please use the space below to tell us anything else you think we need to know. In particular any health matters which you think are advisable for us to be aware of.
It would be a great help to us if you would be kind enough to tell us where you heard about Contact the Elderly.
If you are filling in this form on behalf of someone else, please write your contact details here.
I would like to be offered a place in a "Contact the Elderly" group.
Data Protection Act: I understand and agree that, as part of a Contact the Elderly group, my details will be held in a confidential database which is used only for communications within the Charity
Join in here.
Join us here.
or email us here