Use the form below to register your bicycle with the Radford University Police Department. Be sure to fill in all the blanks. After submitting the registration form, your decal will be mailed to your local address within five (5) working days. Place the sticker on your bicycle, and this will help the Police Department in identifying your bike should it be lost or stolen.

PERSONAL INFORMATION
FULL NAME	Last	First	MI
RU ID#		Anticipated Graduation year: 2008 2009 2010 2011 2012 2013
Phone #	Local:	D.O.B:  (MM/DD/YYYY)
	Perm:	E-Mail:
LOCAL ADDRESS	Address Line 1:
	Address Line 2:
	City State Zip
PERMANENT ADDRESS	Address Line 1:
	Address Line 2:
	City State Zip
BICYCLE INFORMATION
Make:		Bicycle Type: -- Select Type -- Mountain Bike Road Bike BMX Childs Tricycle Tandem Other
Model:		Frame Style: -- Select Style -- Mens Womens Unisex
Serial Number:		Frame Size: -- Select Size -- 15"" 16"" 17"" 18"" 19"" 20"" 21"" 22"" Small Medium Large
Accessories:	Lighting System Horn/Bell Mirror Saddle Bags Kick Stand Basket Child Seat Carry Rack	No. of Gears -- Select Gears -- 24 21 18 12 10 5 3 1 Other
		Frame Color:
		Approximate Value:
		Date of Purchase:
Comments or other Bicycle Description:		Do you have a bill of sale? Yes No