Bicycle Registration Form

Personal Informations

First Name: *

Middle Name:

Last Name: *

Address Line 1: *

Address Line 2:

City: *

State: *

Zip: *

Phone: *

E-Mail Address: *

What is your status? *

Bicycle Information

Make: *

Type: *

If 'Other', Describe:

Color (1): *

Color (2):

Serial or Owner Applied Number: *

Other Identifiable Markings:

Wheel Size: *

Frame Size: *

Style: * Men's Women's

Number of Speeds: *

Check All That Apply: Handbrakes
Headlight
Taillight
Reflector

If you are updating or cancelling your bicycle registration, be sure to include your name and registration number, along with any information to change and select the appropriate checkbox. Otherwise, leave the following section blank.

Registration #:

Registration Purpose: Update Bike Registration Cancel Bike Registration

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