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Student Motor Vehicle Registration Form

Per Year: 1st Decal = $20; 2nd Decal = $5

Date
Last Name
First Name
Middle Initial
Samford ID #
Phone Number
E-mail Address
Vehicle Year
Vehicle Make
Vehicle Model
Tag #
Tag State
Driver's License #
University Status
Parking Status

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.