Cal Maritime Academy Police Department
Bicycle Registration Form
200 Maritime Academy Drive
Vallejo, CA 94590
707-654-1176
Owner Information:
First Name Last Name M.I.
Address Unit/Apt# City
State ZIP Code Phone Number
Driver
License
E-mail
Student ID Date of Birth
Campus
Address
Bicycle Information:
Make Model Color(s)
Men's Women's Speeds Type
Serial
Number
Value $
Comments
I certify that the bicycle I am registering belongs to me and was obtained legally. I will provide such proof upon
request. I understand that registering my bicycle through the university bicycle registration program is not a
guarantee that my bicycle will be protected from theft or loss. Instead, the purpose of registering my bicycle is that
the information I supply on the form may be used to contact me in the event the university recovers my bicycle after
a theft of loss.
Signature:_________________ Print Name Date
Directions:
-Fill in, print out, and sign the form
-Deliver the form in person with your bicycle to Cal Maritime Academy Police Department
Official Use Only:
License Issued: Date Issued: Issuing Officer:
