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Personal Vehicle Registration

* = required field

CARLETON COLLEGE SPORT CLUB PROGRAM
REGISTRATION OF PERSONAL VEHICLE FOROFFICIAL TRAVEL FOR THE SPORT CLUB PROGRAM
Name of person using a personal vehicle (print):*
Club:*
DRIVER OF VEHICLE:
Birth Date:*
Student ID #:*
DRIVERS LICENSE:
State:*
Number:
Date Expires:*
VEHICLE:
Year/Make/Model:*
License Number:*
Owner:*
VEHCILE INSURANCE:
Company:*
Policy Number:*
I hereby certify that I am 18 years of age, that I currently hold a valid driver’s license, that I have not been convicted of a major traffic violation with the past 12 months, that as long as I use my vehicle for Sport Club business I will keep the above insurance (or equivalent) in force, and that all of the above statements are true. I am aware that incase of an accident, my vehicle insurance is primary.
Legal Name:*
Signature:*
Date:*