UNCW Bicycle Registration Form

Fill out this form and print it. Then bring it by the University Police Department to get your Registration Sticker
Last Name:
First Name:
Middle Name:
Today's Date:
   
Student ID Number:
   
Home Phone Number:
UNCW / Local Phone:
Cell Phone Number:
UNCW Email Address:
Personal Email Address:

Home Address / Permanent Address
Local / On campus Address
   
Serial Number:
Make:
Model:
Color (Repainted?):

Fenders Hand Brakes Boys Girls Quick Release Wheels Quick Release Seat

Date Acquired:
Value (or estimate):
Type of Bike: Cruiser Mountain Street Other _____________
Features/additional equipment such as Ubolt lock, water bottle