STUDENT Email form

UNIVERSITY Parking Permit Print form

TRANSPORTATION & PARKING SERVICES Registration

Complete this form and return it to Emorys Parking Office in the Starvine Parking deck on the Clairmont campus.
Email : parking@emory.edu or Fax : 404.727.2673
I. APPLICANT INFORMATION

Full Name:
Last First Middle
Preferred
Mailing
Street Address City / State Zip
Address
Emory ID # Phone number

Emory E-mail address :

II. VEHICLE INFORMATION

Dept. Use ONLY
Make (Manufacturer)_____________
PERMIT #
Model_________________________

License Plate #__________________

Classification:
State of Registration_____________ Pkg. Code:
Primary color___________________ Initials: Date:___/___/___

III. PERMIT / COMMUTE OPTION REQUESTED

Annual permit: $672 I need disability accommodation

(Must confirm with ODS @

OR Tel 404.727.9877 or
TYY/TDD 404.712.2049)

Eagle permit: $100

The Eagle Permit allows students who occasionally drive to campus to park in a designated
parking deck for a limited number of times each year/semester. Emory University students may
purchase this limited-use permit which grants 20 all-day passes for $100. Additional parking may
be purchased as needed at a rate of $100 per 20 parks.

IV. AGREEMENT / SIGNATURE

I understand that I am responsible for obtaining and familiarizing myself with Emorys Parking
Rules & Regulations, and by my signature below agree to abide by them. I also understand
that I am responsible for any fines or fees associated with this permit or the vehicle to which it
is attached, and that non-payment of any fines or fees could result in the immobilzation
or towing of my vehicle and/or deactivation of my permit. I understand that as a student
registered for classes, any outstanding fees will automatically post to my Student Account.

___/___/___
Applicant Name (print) Date
Signature
Signature