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
Rapid Response Vehicles
What is your declared Banding based on ambulance related turnover*
---Associate (turnover n/a)Band A (turnover up to £500k)Band B (turnover £500k – £2m)Band C (turnover £2m – £5m)Band D (turnover £5m - £15m)Band E (turnover £15m 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?
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*Denotes required field