_________Practices away from campus       ___________Meets
 

Vehicle Make:________________________________________________

Year and Model:______________________________________________

Vehicle License Number:________________________________________

Driver's License Number:_______________________________________

Issue Date:__________________________________________________

Expiration Date:______________________________________________

 Insurance Carrier:_____________________________________________

  Policy Number:_______________________________________________

  Expiration Date:______________________________________________
 

Signature:___________________________________________________
Driver of vehicle

I am the registered owner of the vehicle described above on this form
and I authorize the driver, whose name appears above to use this vehicle
to transport him/herself and other students.  I certify that the information
provided above is correct.

Signature:___________________________________________________
Owner of vehicle
 
 

This page last updated:  2/11/04
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