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Bicycle Registration Form

2. BICYCLE REGISTRATION FORM
   Please fill out the below form as completely as possible. If your bicycle is lost or stolen, this will aide officers in locating and returning your bicycle
4. First Name*
   Your complete, legal first name (how it appears on your driver's license or identification card).
5. Middle Name*
   Your complete, legal middle name. If you don't have one, please put NMN.
6. Last Name*
   Your complete, legal last name (how it appears on your driver's license or identification card).
8. Address1*
10. Address2
12. City*
13. State*
14. Zip*
16. Primary Phone*
    Home or cellular telephone number
17. Secondary Phone
    Cellular, work or other number.
18. Additional contact number
20. E-mail address
21. License/ID number
22. License/ID state
26. MAKE*
    The make of the bicycle, such as Trek or Schwinn.
27. MODEL*
    The model name, such as Roadmaster or Spider.
29. Color 1*
    The primary or main color of the bicycle.
30. Color 2
    The secondary color of your bicycle
31. Color 3
32. Color 4
34. Identifying Features
    Please list any identifying features of the bicycle, such as a rear rack, non-factory wheels or tires, upgraded brakes, etc. Anything that makes your bicycle unique.
36. Serial Number*
    Most manufactures put the serial number on the frame behind the crankset. If you cannot find your serial number, check with the manufacturer to see where it is on your bicycle.
37. Owner Applied Number
    If you had a number etched into the frame or otherwise permanently affixed to the bicycle, please indicate that here.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field