NATIONAL TEAM APPLICATION
NAME: __________________________________ DOB__/__/__ AGE:____
CLUB/SCHOOL:_______________________________ USAW#: _____________
ADDRESS: _______________________________|_____________________________
CITY: ___________________________ ZIP CODE: __________________
PHONE: _______________ FAX: ______________ E-MAIL: ______________
CURRENT WEIGHT: ___________ GRADE: ____________________
WEIGHT CLASS YOU WANT TO WRESTLE: ____________________________
CHECK ALL THAT APPLY:
______2002 USA STATE FREESTYLE/GRECO MEDALIST PLACE:
______2002 AAU STATE FREESTYLE MEDALIST PLACE:
______2002 HUSKERLAND FOLKSTYLE MEDALIST PLACE:
______2002 CORNHUSKER STATE GAMES FR/GR/FOLK PLACE:
PAST WRESTLING EXPERIENCE AT THE STATE CHAMPIONSHIP LEVEL
(PLEASE INDICATE SANCTION/YEAR/PLACE)
PAST WRESTLING EXPERIENCE AT THE NATIONAL LEVEL
(PLEASE INDICATE SANCTION/YEAR/PLACE)
PLEASE RETURN ALL APPLICATIONS TO:
COACH PAT GARCIA
14605 "M" Street
Omaha, Nebraska 68137
WK PHONE (402) 457-7105 or HM (402) 894-1147