Para Powerlifting Registration

Para Powerlifting Registration

Name

Name

First

First

Last

Last

Date of Birth

Gender

Home Address

Home Address

Home Address

Home Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Email

Phone Number

USAPP Membership Number

Weight Class (Athletes Only)

Do you have an IPC issued license?

Yes

No

Are you SafeSport certified?

Yes

No

If yes, please list the date of completion

Have you recently had a background check?

Option 1

Option 2

Coaches Name

Coaches Name

First

First

Last

Last

Coaches Email

Registration

USA Adapted Powerlifting Level 1 Clinic

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