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Cauliflower Alley Club 2005 Reunion
Wrestling Seminar Registration Form

** Fill out this form, then print it on your printer **

In order to take part of the Cauliflower Alley Club training seminar, you must send in an application PRIOR to the event. There is no charge for the training. You must be at least 18 years of age and have one year wrestling experience to take part.

Name
 Professional Name
Street Address
 City
State
 Zip Code
Country/Postal Code
 Telephone
E-Mail Address
 Birth Date
Trainer/School
 Years of Training
Sports Background
Height
 Weight
Goals
If you have a close-up photo, please include it with your application. (Not required)

Please send this form to:
Bill Kociaba
1600 South Ocean Drive, #17B
Hollywood, Florida 33019

Any questions can be sent to:epiman@mindspring.com