Application to Register

To register for yourself or a loved one, we offer two methods:

PRINTED FORM:
Simply print this Registration Form and fill it out. Then call (760) 620-5553.

Need help? If you need help filling out the form, just call us and we will be happy to help you with it. We will have our outreach coordinator fill it out with you over the phone or one of our drivers can help you with it on the day of your first ride. We don’t require medical records or letters from doctors.

OR, COMPLETE THE FORM ONLINE:
Complete and submit the application form below to register with us online.

HELP US ACHIEVE OUR MISSION

How You Can Help

Desert Access and Mobility, a 501(c)(3), through the provision of multiple services, empowers the senior blind, low vision, and/or physically disabled population in the west Coachella Valley to develop
and live independently and to their fullest potential for as long as possible.

Desert Access and Mobility, Inc.
a 501(c)(3) non-profit corporation
471 E Tahquitz Canyon Way, Suite 218
Palms Springs, CA 92262