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2023 USA Powerlifting South East Regionals Waiting List Form
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Email
*
Your email
Name as displayed on your Membership ID. (No caps lock please)
*
Your answer
USA Powerlifting Membership number
*
Your answer
Birth date (xx / xx / xxxx format)
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
MX
Raw or Equipped
*
Raw
Equipped
Division
*
Teen I (14-15)
Teen II (16-17)
Teen III (18-19)
Junior (20-24)
Open
Masters I (40-49)
Masters II (50-59)
Masters III (60-69)
Weight Class in KG
*
Your answer
Phone number
*
Your answer
Email Address
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone
*
Your answer
What size shirt? (unisex sizing)
*
XS
S
M
L
XL
2XL
3XL
4XL
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