Travel Training Appointment Request

Travel Training Appointment Request

First Name*

Last Name*

E-mail

Phone Number*

Phone

Age*

Those under 16 must be accompanied by a guardian.

Requested Date (First Choice)*

All trainings must be booked at least 72 hours in advance and are subject to availability.

Requested Time (First Choice)*

Requested Date (Second Choice)*

All trainings must be booked at least 72 hours in advance and are subject to availability.

Requested Time (Second Choice)*

Type of training Requested*

Classroom

Workplace

Individual

How many persons will attend this training?*

If you are unsure, please provide an estimate.

Will you be traveling with a mobility device?*

Yes

Prefer Not to Say

Please briefly describe what you are hoping to gain from this training:*

Which Ben Franklin Transit bus route do you wish to ride*

Select or enter value

Do you certify your trip begins or ends within the Ben Franklin Transit service area?*

Yes

Signature*

Please type your full name.

Requested travel training dates/times are booked in the order they are received and cannot be guaranteed. You will be contacted via phone and email to confirm your training.

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