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Get Amateur Contestants Medical Examination Form

S Are you taking any medication? YES NO; EXPLAIN Previous Hospitalization(s) or surgery (Give dates) Results of the following blood tests must be attached to this application: Hepatitis B surface ANTIGEN Hepatitis C ANTIBODY HIV ANTIBODY ALL MEDICAL AND LAB TEST RESULTS MUST BE DATED, SIGNED AND TAKEN NO MORE THAN 6 MONTHS BEFORE THE REGISTRATION IS SUBMITTED. Answer All Questions Below: (A) BLEEDING TENDENCIES YES NO (L) SEIZURES AND CONVULSIONS YES NO (B) DIABETES YES NO (M) ASTHMA YE.

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