UNCW Bicycle Registration Form

Fill out this form completely, print it, and 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:
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