Para Powerlifting Athlete Application

Regional Hub Event

Athlete Application

First Name *

Last Name *

Date of Birth (MM/DD/YYY)*

Address*

City *

State/Prov. *

Zip *

Country *

Phone (xxx-xxx-xxxx) *

Type of Phone *

Email Address *

International phone numbers may be input, using the leading "+" symbol.

*What is your Gender?

U.S Citizen?*

Weight Classification*

Shirt Size *

Age Classification *

IPC Classified? *

IPC Year

IPC Licensed?*

Attended IPC Event?*

Nationally Classified?*

Year

Where

Attended Level 1 Clinic Event?*

Date (MM/DD/YYYY)

Where

SafeSport Trained?*

Date (MM/DD/YYY)

Background Check Completed?*

Date (MM/DD/YYY)

Background company used

Coach/Trainers Information

Coach/Trainer Name: *

Coach/Trainer Email: *

Coach/Trainer Phone: *

Dietary restrictions (Both pre- and post- competition meal restrictions)*

( if none, enter NONE)

Competition Experience

Years of experience competing at:
National Level

International Level

Most recent national competitions (year & location):*

(if none, enter NONE)

List any international sport competition trips previously taken:*

(if none, enter NONE)

I have read and agree to the USAPP Waiver & Liability Document

I have read and agree to the USAPP Code of Conduct

USA Para Powerlifting Regional Hub Event Application

Regional Hub Event

Athlete Application

Coach/Trainers Information

Competition Experience

USA Para Powerlifting
Regional Hub Event Application