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2. 
4. Owner Information
6. First Name
7. Last Name
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Email Address
18. Bicycle Information
20. Make
21. Model #
23. Serial #
24. Color
26. Type of Bicycle
27. Number of Speeds

29. *Payment of $2.00 (Cash or Local Check Only) is due at the time of registration

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31. 1. Receive an email copy of this form.
32. Email address

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33. Submit

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