APPLICATION FOR REGISTRATION

SPAM ALERT! The Cityride telephone number is NOT changing. That number is

213, 310, 323 or 818 808-7433.

DIRECTIONS

First-Time Applicants

To be eligible for Cityride, you must be aged 65 or older, or have a disability and live in the City of Los Angeles or portions of the following Los Angeles County unincorporated areas: Kagel Canyon, Calabasas, Topanga, Marina del Rey, and areas near Carson and Long Beach.

For Seniors:

A scanned picture of your birth certificate, Medi-Cal card, DMV card, passport or other government-issued document showing your age must be uploaded.

For persons with Disabilities:

A scanned picture of your Metro disabled identification must be uploaded.

To Order:

Upon approval, you may place your first order online by sending a check or money order payable to Cityride. You may purchase $84 in fare value on a quarterly basis for $21 (or $9 for low-income)

For Low-Income

A scanned picture of your Medi-Cal Card or your Supplemental Security Income award letter must be uploaded.

Emergency Preparedness Plan:

As part of the City of Los Angeles' Emergency Preparedness Plan, Cityride can provide your name, address and telephone number to authorized emergency responders. This would be used to locate individuals for possible evacuation in the event of a disaster.

Please Provide Your Contact Information:

Last Name

First Name

M.I.

Home Address

Apt. #

Email Address

City

State

Zip Code

Mailing Address 1 (if different)

Apt. #

City

State

Zip Code

Primary Phone

Date of Birth

Please provide the name of a relative or friend in case of an emergency

Last Name

First Name

Relationship

Primary Emergency Phone

I am attaching documentation that I qualify for Cityride as (choose one):

A Senior Citizen, 65 or older (A copy of your birth certificate, Medi-Cal Card, passport, DMV card, or other government-issued document showing your age).

For Seniors: A scanned picture of your birth certificate, Medi-Cal card, DMV card, passport or other government-issued document showing your age must be uploaded (on the next screen).

Having a Disability (A copy of your Metro disabled identification is acceptable proof. A doctor's note is valid proof for 60 days, after which you must obtain Metro disabled identification).

For persons with Disabilities: A scanned picture of your Metro disabled identification must be uploaded (on the next screen).

Low Income Qualification

I am attaching a copy of my Supplemental Security Income Award letter or Medi-Cal card which qualifies me for the low-income rate.

For Low-Income: To qualify for a low-income rate, a scanned picture of your Medi-Cal Card or your Supplemental Security Income award letter must be uploaded (on the next screen).

Wheelchair Access

I currently use a wheelchair

Emergency Preparedness Plan:

Yes, provide my information

No, do not provide my information

Do you use Access Services?

Yes