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2. Owner Information
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State
11. Zip Code
13. Phone Number*
14. Email Address*
18. Bicycle Information
20. Make*
21. Model*
22. Color*
23. Type*
25. Speed*
26. Serial Number*
27. Approximate Value*
28. Location Purchased*
30. Select One*
    -- Select One --MaleFemale
32. Other Identifying Features
33. Upload Picture of Your Bicycle
35. Terms and Conditions
    By Checking the box below, 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 Napa Police Department 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 Police Department recovers my bicycle after a theft or loss.
37. I agree to the terms listed*

    1. Yes
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field