Powerlifting America Athlete Advisory Council
Name
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First Name
Last Name
Address
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Street Address
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City
State / Province
Postal / Zip Code
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Phone Number
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Powerlifting America Membership Number
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Are you applying for the:
Classic Team Representative
Equipped Team Representative
Junior Age Division Representative
Open Age Division Representative
Masters Age Division Representative
Men's Team Representative
Women's Team Representative
At Large Representative
When did you last compete at a Powerlifting America National Championship, NAPF, IPF World Championship, FISU Championship, or World Games? (list the competition name and date)
List competition name and date
Letter of Interest--Please briefly describe why this role is of interest to you and why you would be a good fit
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