Bicycle Permit Application

permit no.

Last Name	First Name	M.I.

Street	City	State	Zip

I hereby agree to assume all liability for any damage or injury to myself, other persons, or property resulting from, or in connection with, the carriage of my bicycle on MTA-Long Island Rail Road (LIRR) and/or MTA Metro-North Railroad trains, or at any facility used in connection with MTA-LIRR and/or MTA Metro-North rail services.

Having read and understood the attached Bicycle Permit Regulations for MTA-Long Island Rail Road (LIRR) and MTA Metro-North Railroad, I agree to all the terms and conditions governing the use of the joint MTA-LIRR and MTA Metro-North bicycle permit.

I understand that train crews have the authority to bar a bicycle from a train if, in their judgement, it cannot be carried safely, and that failure to comply with the regulations could result in the revocation of my bicycle permit.

SIGNATURE OF APPLICANT

Name	Date

SIGNATURE OF PARENT OR GUARDIAN (if applicant is a minor)

Please print out, complete and mail this bicycle permit application with a $5.00 registration fee (check or money order) or old/damaged permit to (either):

MTA-LIRR	MTA Metro-North Railroad
Cyc-n-Ride	Station Services
Jamaica, New York 11435	420 Lexington Ave - 11^th Floor
(make check payable to LIRR)	New York, NY 10017
	(make check payable to Metro-North)

The bicycle permit you receive in return is valid for use on both MTA Long Island Rail Road and on MTA Metro-North Railroad. Please retain a copy of the rules and regulations for future reference. For further information call the LIRR 1-718-558-8228 or Metro-North 1-212499-4386. Permits may also be obtained in person. At Penn Station, present the completed application and $5.00 registration fee at any ticket window. At Grand Central Terminal, permits are processed at Window 27.

All lost permits require a $5.00 fee for renewal.