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* Required Fields
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First Name * :
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Last Name * :
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Middle Name:
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Nick Name:
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Date of Birth *
MM/dd/yyyy :
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Gender * :
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Address1:
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Address2:
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City :
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State * :
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If Other, Specify
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Postal Zip Code * :
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Country * :
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Birth Place :
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College attended :
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Height * :
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Weight * :
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Years Lifting Experience * :
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Federation * :
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Show Profile? * :
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Yes
No
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Biography :
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User Name * :
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Allowed characters: lowercase {a-z 0-9 _}; Length: 3-20
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Password * :
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Allowed characters: lower and uppercase {A-Z a-z 0-9}; Length: 4-20;
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Confirm Password * :
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Email * :
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Phone * :
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Country Code : -
Phone Number -
Extn
Allowed Only Numbers: {0-9} County Code Ex : USA = 1
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Picture
*
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Primary Picture
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Picture
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Primary Picture
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Picture
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Primary Picture
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Picture
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Primary Picture
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| Note : Your video displays as link. Give it a Title up to 100 characters |
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Video :
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Title:
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Video :
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Title:
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Video :
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Title:
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Paypal Confirmation Number :
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I hereby grant permission to Ipowerlift.net to use my photographs and video links submitted for creating my profile for web, print and media
publications without further consideration, and I acknowledge that Ipowerlift.net will treat the photographs and video links at its discretion.
I also acknowledge that once my photos and links have been released to Ipowerlift.net or the affiliated web publications, the images can
be downloaded by any computer user. I am also agreeing that I am at least 18 years of age and own all rights to the photos and videos links that I have
submitted. Therefore, I agree to indemnify and hold harmless from any claims Ipowerlift.net .
I Accept
I Decline
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