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Bicycle Registration Form

Date
Last Name
First Name
Middle Initial
Samford ID #
Phone Number
Campus Address
Home Address
City
State
Zip
E-mail Address
Bicycle Make
Bicycle Model
Speed
Serial Number
Color
Size

I understand that furnishing false information or non-compliance with University parking and traffic regulations may subject me to fines, revocation of the privilege of operating a vehicle on campus or other disciplinary action.