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USA Wrestling 2020-24 Medical Application
If you wish to include a resume with this application please email a copy to Andrew Ernst at
andrew.ernst@usopc.org
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* Indicates required question
Email
*
Your email
Full name as it appears on your passport.
*
Your answer
Home address, City, State and Zipcode
*
Your answer
Cell phone number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Warm Up Top Size
*
Small
Medium
Large
Extra Large (XL)
Double XL
Triple XL
Warm Up Bottom Size
*
Small
Medium
Large
Extra Large (XL)
Double XL
Triple XL
Shoe Size
*
Your answer
Present Occupation and Current Employer
*
Your answer
Please check the boxes for all medical licenses that you have. If it is other, please list the license.
*
MD
DO
ATC
MT
Other:
Required
Languages other than English if applicable.
Your answer
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