2023 USA Powerlifting South East Regionals Waiting List Form
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Email *
Name as displayed on your Membership ID. (No caps lock please) *
USA Powerlifting Membership number *
Birth date (xx / xx / xxxx format) *
Gender *
Raw or Equipped *
Division *
Weight Class in KG *
Phone number *
Email Address *
Street Address *
City *
State *
Emergency Contact Name *
Emergency Contact Phone *
What size shirt? (unisex sizing) *
A copy of your responses will be emailed to the address you provided.
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