| Seminar Location: | Date of Seminar: |
| Name of Applicant: | |
| Address: | |
| City: | Province/State: |
| Country: | |
| Postal Code: | Phone: |
| E-Mail Address: | |
| Present Level: | Date Received: |
| Arm Wrestling Experience(years) | Experience as an Organizer(years) |
| Experience as a Referee(years) | As a Head Referee(years) |
Local - Provincial/State - National - International - World |
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| Level Applying For: | Spotter | Junior | Senior | Masters |
| Signature |