Company Registration Number
VAT Registration (if applicable)
CQC Registration Number
Please describe the regulated services you provide*
Please state how many of the following types of vehicles you currently operate:
Accident & Emergency None1-2526-5051-7576-100101+ High Dependency None1-2526-5051-7576-100101+ Patient Transport None1-2526-5051-7576-100101+ Rapid Response Vehicles None1-2526-5051-7576-100101+
What is your declared Banding based on ambulance related turnover* ---Band A (turnover up to £500k)Band B (turnover £500k – £2m)Band C (turnover £2m – £5m)Band D (turnover £5m plus)
I declare that all the information given is accurate and forms the basis of our application for membership*
Please prove you're not a robot* What number would you dial for an ambulance in the UK?
Please tick this box if you are happy to receive the occasional marketing email from us. We very rarely send marketing information, and would only contact you if we felt it was for a reason that you would genuinely want us to.
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