Accessibility Companion Scheme Application Form

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: *

Please note:

Melrose Club & Racing Lounge - Your application will be passed to our bookings team to contact you for processing. Access scheme discounts cannot be applied to an order that has already been placed.

Ebor/Knavesmire/Parade Ring Restaurant - Once the application is approved your discount will be confirmed to the hospitality team. Please ensure the 6 numbers of your order number following YRK is included on this application.

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

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 *** - must be taken from the document you are submitting
Document Additional Document (if required)	Disability Living Allowance (DLA)
Document Additional Document (if required)	Attendance Allowance (AA)
Document Additional Document (if required)	Personal Independence Payment (PIP)
Document Additional Document (if required)	Armed forces Independence Payment (AFIP)
Document Additional Document (if required)	Scottish Adult Disability Payment
Document Additional Document (if required)	Proof of Registered Blind (Certificate)
Document Additional Document (if required)	Access Card (Nimbus)	Card ID No.

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.