OVH BIKE, TRIKE, SCOOTER/WHEELCHAIR REGISTRATION FORM

OWNER NAME: ____________________________________________________________

OVH ADDRESS: _________________ [ ] VETERANS HALL [ ] GIFFIN BLDG [ ] SECREST BLDG

TYPE OF VEHICLE REGISTERED (ONE REGISTRATION PER VEHICLE):

[ ] MEN´S BICYCLE        [ ] WOMAN´S BICYCLE [ ] RECUMBENT BIKE [ ] ADULT TRICYCLE

[ ] QUADCYCLE              [ ] SPORT W/C                [ ] ELECTRIC W/C          [ ] ELECTRIC SCOOTER

BRAND NAME: ______________________ MODEL NAME/NUMBER: ___________________

MAIN COLOR: ___________   SECOND COLOR: __________ TRIM COLOR: ______________

FRAME SIZE: ___ [Bikes: Crank Shaft Center to effective top tube plane – measured on the top of top tube at the junction of the top tube and the seat tube.  ***Note – Wheel Size is NOT Frame Size!]

WHEEL SIZE(S): ___________   ___________ [Do not count anti-tip rollers or wheelie bar wheels.]

SERIAL NUMBER: ___________________________________________________________

LOCATION OF SERIAL NUMBER: [ ] Bottom Bracket Shell   OTHER LOCATION: _______________

_________________________________________________________________________

EQUIPMENT/ACCESSORIES ATTACHED: _________________________________________

PURCHASE PRICE: $ ________.______                   PURCHASE DATE: ____/____/_________

OWNER SIGNATURE: ________________________________________________________

DATE OF REGISTRATION: ____/____/________

+ + + +  Use reverse side for additional identifying information.  + + + +

RSCC/SWOG HPV/PPV REGISTRATION FILE

F0RM DATE:  5/23/2002