CAMPUS PARKING REGISTRATION
Employee Name_______________________________ Date_____________
Millikin ID# _______________________
University Status:
Please circle one: Admin Faculty Staff
Address Home _______________________________ Phone #_______________
_______________________________
Campus _______________________________ Phone#_______________
Primary Vehicle
Year________ Make___________ Model__________ Color_________
License Plate #_____________ State______
Owner_______________ Address____________________________________
____________________________________
2nd Vehicle
Year_________ Make__________ Model__________ Color__________
License Plate#___________ State_____
3rd Vehicle
Year________ Make__________ Model__________ Color__________
License Plate#___________ State_____
Permit #________ Signature___________________________________
*Please pay at the cashier’s office and pick up the permit at the Security Department located at Walker Hall.