Bicycle Registration / New Form

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Use this form to pay the one-time $10 registration fee for your bicycle. This registration fee is to purchase the tamper resistant and theft deterring 529 Shield for your bicycle’s complete protection. Once paid, you will receive a Confirmation email with a link to the University’s Project 529 registration page. Save this Confirmation email, bring it along with a Government-issued or University ID to the Shield pick-up location to collect a Shield for your registered bicycle.

First Name:*

Last Name:*

Phone Number:*

Personal Email:*

Local Address:*

Zip Code:*

University Affiliation*

Non-affiliated

I would like to pay with a C-FOAPAL

Enter the C-FOAPAL of the account you wish to charge:

Please enter a valid C-FOAPAL in the following format: x-xxxxxx-xxxxxx-xxxxxx-xxxxxx. We will work with your business office to process this payment.

Unit Contact Name:

Unit Contact Email:

C · FOAPAL Special Instructions:

Please provide any additional instructions regarding your C-FOAPAL payment.

Amount Due: $10.00

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