Accessibility Companion Scheme Application Form

Please complete the following form to submit application

Name of person*:

Address 1*

Address 2*

Address 3

City*

Postcode*

Name of person completing this application:

(incase we need to contact you regarding the application)

Contact number: *

Email address: *

Section 1

County Stand and Grandstand & Paddock Enclosures - Up to 4 race dates can be applied for per application, a valid 6 digit order number is required for each date:

Enclosure*	Raceday Date*	Order Number* (can be found on you email confirmation)

Section 2

All other Enclosure types must be applied for as a single day per application.

Melrose Club & Premier Racing Lounge - Please call the bookings team to process your order once the application has been approved.

Hospitality - Once the application is approved your discount will be confirmed to the hospitality team.

Enclosure*	Raceday Date*

If the criteria is met for the application to be successful we will allocate one ticket for your Accessibility Companion on each above requested racedays. For additional racedays please complete a new application

I agree to the above details being securely held by York Racecourse until the last raceday of this application.

Yes No

If you select "No" do not continue with this application as we are not permitted to hold your documentation on file and you should therefore present it on the raceday you are attending along with photographic ID. Please note if your documents do not meet the criteria for the scheme when presented on the raceday a ticket will not be issued.

Type of document being submitted as evidence of qualifying for the scheme:

		Document Date
	Disability Living Allowance (DLA)
	Attendance Allowance (AA)
	Personal Independence Payment (PIP)
	Armed forces Independence Payment (AFIP)
	Proof of Registered Blind (Certificate)

All documents submitted must be current, Award letters to be dated within the last year or to clearly state expiration or next review date. Any application submitted with documents that do not meet this criteria will not be processed.

Please confirm you have read the Accessibility Companion Scheme Policy

If you are applying on behalf of someone else please confirm you have authority to do this.