Name:
Email Address:
Telephone (please include prefix +)
How many people in your group. Please state as per the example; 2 people(1 chair user + 1 other)
Arrival Airport
Date of Arrival dd/mm/yy
Airline Name and Flight Number if known
Time of arrival if known (24 hour clock ie 19:35 etc)
Do you require an adapted vehicle or can you transfer into a standard vehicle from a wheelchair	Yes No Can Transfer
Which type of wheelchair do you use	Manual Electric Scooter
Is your manual chair foldable	Yes No
For electric wheelchairs please provide as much detail as you can regarding dimensions of the chair, in particular the height from the floor to the top of the wheelchair users head
How many cabin sized bags will you be carrying 55x40x20 cm	not known 1 2 3 4 more than 4
How many checked in bags will you be carrying	not known 1 2 3 4 more than 4
Will you be arriving with outsized baggage as classified by airlines such as a portable hoist	Yes No Undecided
Departure airport
Date of Departure dd/mm/yy
Airline Name and Flight Number if known
Time of Departure if known

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