Bike Registration Form
Your Name
First Name
Last Name
School Email Address
example@example.com
Contact Number
Please enter a valid phone number.
School Affiliation
Please Select
Staff
Student
Other
Do you live on campus?
Please Select
Yes
No
Bike Information
Serial Number
Model
Please indicate any identifying items on your bike:
Bell
Lights
Basket
Horn
Bottle Holder
Other
Please briefly describe your bike, primary color, accent color etc.
Please take a picture of your bike.
Date
-
Month
-
Day
Year
Date
Your Signature
Clear
Submit
Should be Empty: