Graduate Student Parking Registration Form
January 2016
Last Name
First Name
Class Standing:
Graduate
Print Form
FY16
Messiah ID #
Registration Request Date:
January 4 - 8, 2016
Home Address
Address
City
State
Country
Cell Phone #
Zip Code
Driver & Vehicle Info
Driver's License Number
State
Insurance Company Name
Model Year
Insurance Policy #
Insurance Policy Owner Name
Make
Color
Model
License Plate #
State
Notes
Return your completed form to [email protected] no later than November 30, 2015.
Office Use Only:
Permit #
Lot:
Date Issued:
Fee:
Date Expires:
January 8, 2016
Visitor Parking: VV
$0
Issued by:
This form is required to be updated annually. Last update by Bryan Stout as of November 19, 2015