Bicycle Diversion Registration

Complete the following form to register for the Bicycle Diversion Program. Once you have completed this form, it will take you to the Bicycle Safety Quiz. You must complete the bronze, silver and gold levels. Upon successful completion of the safety quiz, send your certificate to the City of Champaign Legal Department, 102 N. Neil St. Champaign, IL 61820 or [email protected].

Name*
First Last
Address*
Street Address City State ZIP Code
Date of Birth*
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Phone Number*
Email*
The undersigned, by signing below and completing the Bicycle Diversion Program Safety Quiz, offers to settle the case or cases alleged on the enclosed Notice(s) to Appear and deems this as final settlement of any and all claims related to the offense(s). I freely and voluntarily waive my right to plead guilty or not guilty, the right to be represented by an attorney in this matter, the right to a trial by judge or jury, the right to confront witnesses and hear evidence against me, and the right to present witnesses and evidence on my own behalf.
Type your name below to accept these terms.*
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