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Michigan Xtreme, LLC 
5355 Northland Drive NE
Suite C #134

Grand Rapids, MI 49535

Training Center - South
3494 Plainfield Avenue NE

Grand Rapids, MI 49525

Training Center - North
9901 Wolven Avenue NE

Rockford, MI 49341

Office Contact
Phone:(616)635-7559
Email: michiganxtreme@gmail.com

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Wrestler's Name
Date of Birth
Address
City/ State/ Zip
Parents Name
Primary Phone Number
Alt Phone Number
School/ MYWA Club
Grade
Weight
Email Address
Membership Start Date
Membership Renewal Date

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