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Parking Pass Request
Name of driver
Home Address
Mobile Phone Number
Campus Address
Campus Phone Number - if applicable
Vehicle Make
Vehicle Model
Vehicle Year
Vehicle Color(s)
Vehicle License Plate Number
I have read, understand, and agree to the parking rules and regulations found in the AB Student Handbook.
Click to confirm

Your signature on this agreement indicates the information is accurate and complete, authorizes Alderson Broaddus to inquire about any matters referenced above, and authorizes those contacted to release information. This information you and others provide will be reviewed to determine if and where you will be assigned to on-campus parking. If any of the above information changes following submission of this agreement, you must notify Alderson Broaddus immediately in writing to:

Campus Safety, 101 College Hill Dr, Box 2062, Philippi, WV 26416

Signature
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