Arsenal Football Club Away Game applying for: Vs ARSENAL FC Premiership/FA Cup/ Europa League/ Carabao Cup*please delete as applicable. Applications for fixtures more than 2 months ahead will automatically be Disabled Supporters Away Match Ticket Application Form rejected. Type of ticket requested: I wish to apply for the following disabled supporters ticket: Completed form should either be posted to: Wheelchair user ( Disability Liaison Team, Arsenal FC, Highbury House 75 Drayton Park, London N5 1BU ) Ambulant Disabled i.e. walking difficulties ( Email: ONLY if you have pre-registered your credit/debit card to: disabilitytickets@arsenal.co.uk (Please ensure that you insert in the subject box the name of match you are applying for). faxed to: 0207 704 4041 Hearing Impaired ( ) ) Visually Impaired* ( ) * if available, do you require a match commentary headset [ ] yes [ ] no Please state your age if under 16 or over 65 ( ) Member details: Supporters Name: Gold/Purple Membership No: Address: Tel/Mobile No: Email: Travel: If you are allocated tickets and would like to book on the Arsenal Travel, contact 0207 619 5000 Option 1 If you wish to send in your application by email - have you pre-registered your debit/credit card? [ [ ] yes - last four digits of registered card no: ………… / Expiry Date…………………….. ] no – you will need to complete the online registration form before you can email in this application form If you wish to apply by post or fax: Credit/Debit Card Number: Note Electron cards are not accepted. Cheque: Should be made payable to Arsenal Football Club and ideally left blank (as we are not able to guarantee which ticket you may be allocated) as we will insert the correct amount. Card no: Valid from: Expiry Date: Issue No: Card holder’s name If successful, you will be sent confirmation of your seating details and both membership cards will be activated for the game. For office use only: Away Credits [ ]