LIRR Bicycle Permit

Please complete this application, print it, and take it to a LIRR station or mail it with $5 payment:

PERMIT NO.
PLEASE PRINT or TYPE Mr. Mrs. Ms. (Check one) Sex : Male Female
First Name, MI, Last Name:
Date of Birth:
Mailing Address:
City, State, ZIP:
Home Telephone:

CONDITIONS

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 and Metro-North Railroad trains or any facility used in connection with Metro-North and Long Island Rail Road rail services. Having read and understood the bicycle regulations and restrictions, I agree to all the terms and conditions governing the use of the bicycle permit. I understand that train crews have the authority to bar a bicycle from a train if, in their judgment, 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	Date of Application

Signature of Parent or Guardian (if applicant is a minor)

I plan to use my own permit between __________ and ___________ stations on Weekdays Weekends

By Mail: Complete this application and mail with a $5.00 registration fee (check or money order payable to LIRR) to:

LIRR Bicycle Permits
Jamaica Station Mail Code 1973
Jamaica, NY 11435

All lost, damaged, or worn-out permits require a $5 renewal/replacement fee. Please fill out this form and include payment as specified. If you are exchanging a permit, please include your old permit as well.

Bicycle regulations and restrictions apply, and are listed on the Bicycle Permit. Please be sure to read them when you receive your permit.

For further information call (718) 558-8228 or LIRR Travel Information.