BICYCLE & COMPUTER REGISTRATION

Print and drop-off version: here

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Personal Information:

First Name:
Middle Initial:
Last Name:

Address:

City:   State:   Zip:

Phone:
Email:
Date of Birth:
Student ID:

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Relative's Information:

Name:
Phone:
Address:

City:   State:   Zip:

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Bicycle Information:

Brand:
Model/Type:
Serial #:
Color:
Value:
No. of Gears:

Other Information:

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Computer Information:

Laptop Desktop Other

Brand:
Serial #:
Color:
Value:

Other Information: