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Student-Athlete Profile/Sports Medicine Update, 2009-10

Please complete and submit this electronic document to update your Clemson University Student-Athlete/Sports Medicine Profile for the upcoming year.

First Name: Last Name:
Sport:

Home Mailing Address:

Street or PO Box:    
City: State: Zip Code:
Home Phone:    
Cell Phone:    

Parental Contact Information:

First Name: Last Name:
Mailing Address (If different from above):
Street or PO Box:    
City: State: Zip Code:
Daytime Phone:
Cell Phone:

Since August of 2008 (time of last reporting), has there been any change in your:

Medical Insurance Coverage? Yes No
Dental Insurance Coverage? Yes No
Prescription Coverage? Yes No

If you answered NO to all three of the above, proceed to document submission.
If you answered YES to any of the above, press Submit and proceed to, download and print the Returning Athlete Change of Information form  .

Failure to supply this information will cause delays in your Preseason Physical Exam and Clearance to Participate in Clemson Athletics.

 

I understand that submitting this form electronically will update my Sports Medicine Profile for 2009-10. All of the information I have provided is accurate. I will inform Sports Medicine immediately if any of this information changes prior to my arrival on campus.



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