Gold Lifeline Activation Form
Upon activation, your membership card and key tag shall be valid for free emergency taxi rides for a period of 12 full months, at which time we may contact you for possible renewal of this emergency taxi ride service.
Email address *
Enter Your 6-Digit Membership Number (Front of Card) *
Your answer
Your Name *
Your answer
Your Address
Your answer
Your Phone Number
Your answer
Your Cell Number
Your answer
By actual use of this membership card, member agrees to the following terms and conditions: Member agrees to utilize this emergency ride service only when faced with a dangerous and/or life threatening situation, or as follows: Avoiding a drunk or menacing driver, illness, vehicle breakdown or accident while vehicle is in tow (verifiable by a police report or licensed towing firm), escaping a threatening date or any abusive situation. Member must convey to operator when calling for an emergency ride ones name. home address, cell number, member ID number appearing on key tag, where member is presently located, nature of emergency and that member may only be brought to their stated home address or a police, hospital or licensed shelter, unless out of town (100+ miles from ones home address) and registered as a guest at a hotel or staying at a home of a friend or family, then, member will be brought to either one of those locations in addition to the foregoing locations mentioned herein. Student and Gold Lifeline pays for entire cab fare up to $200.00 per incident plus 15% gratuities, no out-of-pocket payment is required by member in relation to this emergency ride service. Member must be in possession of a valid, activated Gold Lifeline Membership Key Tag and present same to driver of the contracted emergency car service prior to being driven to ones destiny, failure to provide such required identity shall result in both the refusal by Student Lifeline and Gold Lifeline to provide payment for the requested transportation and grounds to cancel the membership associated with that specific ID account number without the right for reinstatement, no refunds shall be made on membership fee. Member shall not seek to change the destination where member is to be brought, other than to the destination given to the Gold Lifeline operator at the time of the initial request for an emergency ride service, doing so, shall result in the member's responsibility to pay for the car service ride in its entirety and grounds to cancel the membership associated with that specific ID account. Any attempt to provide member's ID account number in any other form or method, other than presenting an actual Gold Lifeline key tag to an emergency car service driver as evidence of ones membership shall not be honored as an acceptable form of ID and shall be grounds for cancellation of membership associated with that specific ID account number without the right to reinstatement, no refunds shall be made on membership fee. Any misrepresentations by member, in any manner whatsoever, seeking to manipulate or undermine this emergency ride system by falsification of information respecting an emergency event that is discovered by Gold Lifeline or Student Lifeline as being untrue shall result in an immediate and non-reinstatable termination of member's ID account without refund of member's fee. Member understands that this emergency ride system is in place to provide true emergency rides to its stranded members and that it is not to be misused for any other purpose. Student Lifeline and Gold Lifeline does not provide reimbursements of cab fares or any other form of service, other than that which is outlined herein and is hereby fully acknowledged and accepted by member. Member hereby agrees to save and hold harmless Gold Lifeline, Student Lifeline and the parent corporation: American Student Books, Inc. and its affiliates for any act of commission or omission relative to the stated and unstated services and possible activities by same or on the part of any livery or car/taxi service, or individual contracted to provide stated services, including any fines, suits, liability claims, proceedings, demands, actions arising or growing out of or otherwise connected to any taxi, livery, limousine, or their employees, contractors, etc., either as a result of their performance or lack of same. Contracted car and livery services have no direct affiliation with Gold and Student Lifeline, but are hired independent services paid by same, it is the obligation and responsibility of member to either accept or reject the services of these car, livery or taxi services independent of Student and Gold Lifeline. Member agrees to enter and accept a car/taxi/livery service ride to ones destination at member's exclusive and sole option, risk and decision.To reiterate, Nothing contained herein should be read or construed as an obligation on the part of Student Lifeline or Gold Lifeline or American Student Books, Inc. to supply a taxi or car service ride for or to any authorized Gold Lifeline Member each and every time or occasion that a call is placed with a participating taxi firm and a ride is requested. However, Gold Lifeline makes every attempt, as it has since 1988 to provide each member with the best possible service humanly possible when a member is in distress as evidenced by its unimpeachable historical record of performance in this field of safety and potentially life-saving enterprise. Gold Lifeline™ is a product of the Student Lifeline® Emergency Taxi Ride Service that began operations in 1988 in providing free & unlimited emergency rides for stranded students escaping dangerous and compromising situations, now available to the adult population under this new title. We have over 30 years of successful, potentially life-saving services with an A+ Rating (since 1988 and as of this printing) with the BBB, and now extend this emergency service to the general public, nationwide. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service