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Get USA Wrestling Claim Form 2012-2024

Ve Colorado Springs, CO 80918 Wrestling Card Number: Toll Free (866) 523-3199 ___________________________ Class 2 Class 1 PART I – POLICYHOLDER’S REPORT 1. Claimant’s Name (Injured Person) 2. Social Security Number 3. Gender M F 4. Date of Birth 5. E-Mail 6. Address of Injured Person and Best Contact Phone Number (Include Area Code) 7. If Applicable, Parent’s Name, Address, and Best Contact Phone Number (Include Area Code) 8. Date and Time of Accident 9. Place where Accident Oc.

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