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Faculty & Staff Motor Vehicle Registration Form

Date
Last Name
First Name
Middle Initial
Samford ID #  (Banner employee id or social security number)
Campus Address
(dept. and building)
Phone Number
E-mail Address
Vehicle Year
Vehicle Make
Vehicle Model
Tag #
Tag State
Driver's License #
Additional vehicles if applicable

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.