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Bicycle Registration Form

Personal Information
* Last Name
* First Name
  Email
  MavID Number (1000)
DO NOT PROVIDE YOUR SSN
  Select Only One Faculty Staff Student Other
  Local Phone
* Local Address
  City
  State
* Zip Code
Bicycle Information
* Serial Number

How to Find Serial No?
serial_number 
  Manufacturer
  Model Men's    Women's
* Color
  Style
* Expected Graduation Date (REQUIRED):     Semester:     /   Year: 

All of the above information is true and accurate to the best of my knowledge.  I will immediately notify the Crime Prevention iUnit in writing of any changes.

I understand that my IP address will be submitted with this form to establish accountability in the event of harassing and/or fraudulent form submissions.

Thank you!