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WMU Bicycle Registration Form
*
= required
Name
*
Owner Date of Birth
Email
*
Phone Number
*
LOCAL/CAMPUS ADDRESS
Street
*
Apt/Unit
City
*
State
*
Zip
*
PARENT/PERMANENT ADDRESS
(if different than above)
Street
Apt/Unit
City
State
Zip
BICYCLE INFORMATION
Add Photo of Bicycle (optional)
[image must be: png, jpg, or gif]
Make/Brand
*
Model
Color
*
Secondary Color
Serial Number
*
Owner Applied Number (if you stamped your own number)
Frame (men's/women's/unknown)
Type (mountain bike, BMX, street, other, unknown, etc)
No. of Speeds (gears)
Wheel Size
Additional Information (accessories, damage, upgrades, etc)
You may also additional contact information here.
Leave this blank. If anything is typed in this field all your information will be lost:
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