_________Practices away from campus       ___________Meets
 

Vehicle Make:________________________________________________

Year and Model:______________________________________________

Vehicle License Number(s):______________________________________

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/or other students.  I certify that the information
provided above is correct.

Signature:___________________________________________________
Owner of vehicle
 
 

This page last updated:  8/22/04
webpage by PLA