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2. PRIMARY APPLICANT INFORMATION
   Please note that you need copies of you need digital copies of photo ID(s), proof of Lyons residence and head shot for each applicant to complete this application.
4. First Name*
5. Last Name*
7. Phone Number*
8. Email Address*
9. Date of Birth*
   Date of Birth
11. Address*
13. City*
14. State*
15. Zip Code*
17. Select The appropriate category for the primary applicant*

    1. Regular Pass (ages 20-65)
    2. Youth (ages 6-19)
    3. Senior age (65+)

    Note: Children ages 5 and younger ride free with a fare-paying adult.

18. Upload Headshot*
    Take a photo of the primary applicants head and shoulders and upload it here. Please take the photo against a white backdrop and remove any hats or sunglasses.
20. Upload Copy of ID*
    Scan or take a photo of your ID and upload it here.
21. Upload Proof of Address*
    Scan or take a photo of a a document that has your physical address on it and upload it here.
25. ADDITIONAL APPLICANTS (Family Members in the Same Household)
    If more than two additional applicants please complete the two below and then start a new form with additional applicant information. If you are only applying for yourself please scroll down to the submit button below.
27. First Name (Additional Applicant 1)
28. Surname (Additional Applicant 1)
29. Date of Birth (Additional Applicant 1)
    Date of Birth (Additional Applicant 1)
31. Select Category (Additional Applicant 1)

    1. Regular Pass (ages 20-65)
    2. Youth (ages 6-19)
    3. Senior Age (65+)
32. Upload Copy of ID (Additional Applicant 1)
    Scan or take a photo of your ID (if over 18) and upload it here.
33. Upload Head-shot (Additional Applicant 2)
    Take a photo of additional applicants head and shoulders and upload it here. Please take the photo against a white backdrop and remove any hats or sunglasses.
35. First Name (Additional Applicant 2)
36. Surname (Additional Applicant 2)
37. Date of Birth (Additional Applicant 1)
    Date of Birth (Additional Applicant 1)
39. Select Category (Additional Applicant 2)

    1. Regular Pass (ages 20-65)
    2. Youth (ages 6-19)
    3. Senior (65+)
40. Upload Copy of ID (Additional Applicant 2)
    Scan or take a photo of your ID (if over 18) and upload it here.
41. Upload Head-shot (Additional Applicant 2)
    Take a photo of additional applicants head and shoulders and upload it here. Please take the photo against a white backdrop and remove any hats or sunglasses.
45. RTD Bar code instructions

    Please remember to download the RTD application and follow the directions to add the barcode. Once you have added your barcode, Town of Lyons staff can add the Eco Pass funds to your account. 
    
    Thank you!

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field