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2. 
3. BICYCLE REGISTRATION FORM
4. NOTE:
   The City of Fairbury is only able to register bicycles for City of Fairbury residents
6. Instructions:

   1. Complete the form, submit and/or print (if unable to print, the City Clerk's Office can print a copy for you)
   2. Bring printed copy to the City Clerk's Office, City of Fairbury office (612 D Street, Fairbury, NE)
   3. Pay the registration fee of $3.00
8. First Name*
9. Last Name*
10. Email Address
12. Street Address*
13. City, State, Zip Code*
15. Phone Number*
16. Type of Phone
    -- Select One --HomeWorkMobile
17. Alternate Phone Number
18. Type of Phone
    -- Select One --HomeWorkMobile
20. BICYCLE DESCRIPTION
21. Select Bicycle Style*
    -- Select One --BMXCruiserHybridMountain BikeRecumbentRoad/TouringTandemTricycleOther
22. Select Frame Type*
    -- Select One --Men'sWomen's
24. Bicycle Primary Color*
25. Bicycle Secondary Color*
26. Number of Speeds*
27. Bicycle Tire Size*
29. Please describe additional information about handlebars, extensions, tape, grips, etc (color/material)
31. Upload a file or picture
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field