Bike and Scooter Registration Form

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1. UVA Affiliation
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2. First Name
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3. Last Name
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4. Email Address
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5. Local Phone Number
6. Home Phone Number
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7. Local Address
8. Home Address
9. Make of Bicycle/Scooter
10. Model of Bicycle/Scooter
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11. Bicycle/Scooter Serial Number
12. Bicycle/Scooter Color and or Description
13. Bicycle/Scooter Value
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