Arizona State Powerlifting

State-___ Zip-_________ E-mail:_____________________ Phone: (____)____________

Unequipped Bench Press Only ( wraps & belt allowed) : _____, _____, ______, ______

Power Sports© (raw) Full Meet Divisions Only- _____, ______, ______, ______,

Power Sports© Individual Events Entered (Curl, BP, DL)- _____, ______, ______, ______

Total Amount Enclosed : $_____ Check #_____ Total Number of Divisions Entered:____

Card #-______ ______ ______ ______ Expires-_______ Name on Card-(print) ____________________________

I realize this Competition is an Anabolic Steroid Free Meet and I MAY be Tested by Urinalysis

Athlete’s Signature:_________________________ Date:__________ No Refunds on No Shows

Parent’s Signature if Athlete is under 18 years of age:_____________________ Date:_____

No Refunds on No Shows

   NASA Arizona Regional On Line Credit Card Entry Form - Late Fee's Begin Nov. 3rd, 2008

    First Name-    Last Name-

    Wt. Class-   Age-   DOB-     Phone-

   Address- City-

   State- Zip-        E-mail Address-

   Equipped Powerlifting (Suit, Wraps, Belt allowed) - ,

    Unequipped Powerlifting Division(s) Entered (i.e. Pure, Open, M-1 etc)-,

   Equipped Bench Press Division(s) Entered (i.e. Pure, Open, M-1 etc)-,

    Unequipped Bench Only Division(s) Entered (i.e. Pure, Open, M-1 etc) -,

    Power Sports Full Meet Division(s) Entered (i.e. Pure, Open, M-1 etc) - ,

   Power Sports Individual Divisions (BP, Curl, DL) Entered - ,

    Push Pull (equipped) Divisions Entered (i.e. Pure, Open, M-1 etc)- ,

    Grand Total Number of Divisions Entering-

    Total to Charge this Card -$   Type of Credit Card-

    Credit Card Number                                         (example 1234-5678-9101-2344)

    Expiration Date of Credit Card Card - (example 06/23/03)

Comments or Questions-

Read this Waiver Completely Before Submitting - All Unsigned Entries Will Be Returned

In consideration of your acceptance of this entry, I hereby waive, for myself, my heirs and assigns, any and all claims for injury or damages which I may incur by virtue of my competing in this contest as against Rich Peters, NASA LLC Powerlifting, NASA, Westwood High School and the school district, the facility used and any and all of their agents and employees. I also realize that the sport of Powerlifting is a high risk sport and that I could be injured. I certify that I am in good physical health and have no serious health problems and that I assume full responsibility for such conditions. I realize that if I use the False Grip or Open Grip that it is a dangerous method of BP'ing and I assume full responsibility if I choose to use this method to BP. I also agree to submit to drug testing at any time during this event if I am asked to do so. I certify that I know and understand completely the NASA policy for drug testing and NASA's use of it's coefficient system and agree to their policies.I also realize that I am fully responsible for my well being and safety in the warm up room, on the lifting platform and while I am lifting at this event. I also certify, by my signature, that I have read this waiver and fully understand and accept it’s terms. I do hereby verify my acceptance by my signature below. I also realize that children and non lifters are NOT allowed in the warm-up room for any reason. I also give NASA, Rich Peters and all other parties involved in this meet permission to post my name and make my name public if I fail any Drug Test if they choose to do so.

Do Not Sign This Waiver Before Reading It Fully and Carefully. If you do not accept it’s terms, DO NOT sign it.

I agree to the terms of this waiver and do so indicate by my submission this Credit Card Entry.

I Realize that this Competition is an Anabolic Steroid Free Meet

No Refunds on No Shows

I to the terms of this waiver (Initials)-

114, 123, 132, 148, 165, 181, 198, 220, 242, 275, 308 & SHW

Women’s Weight Class

Return Entry and Entry Fee’s

Entry Fee’s for Powerlifting & Bench Press Only (equipment allowed)

$55.00 for first division entered, $35.00 for each additional entry. Late Fee after Deadline Date is $5.00 additional fee, for first division entered. Cash Only for all late entries. All High School Lifter's Entries are $40.00 each.

“Power Sports©" Entry Fee’s

How To Enter - Using The Entry Form Properly

Team Entry Fee

$40.00 per Team Entry. This fee is for the Team Trophy. Team Rosters MUST be turned in by the start of lifting on Saturday. Trophies for 1^st thru 3^rd for Powerlifting, Bench Press Only and Power Sports Teams. Maximum of 10 members per team.

I realize this Competition is an Anabolic Steroid Free Meet and I MAY be Tested by Urinalysis

114, 123, 132, 148, 165, 181, 198, 220, 242, 275, 308 & SHW

Women’s Weight Class

Return Entry and Entry Fee’s

Entry Fee’s for Powerlifting & Bench Press Only (equipment allowed)

$55.00 for first division entered, $35.00 for each additional entry. Late Fee after Deadline Date is $5.00 additional fee, for first division entered. Cash Only for all late entries. All High School Lifter's Entries are $40.00 each.

“Power Sports©" Entry Fee’s

How To Enter - Using The Entry Form Properly

Team Entry Fee

$40.00 per Team Entry. This fee is for the Team Trophy. Team Rosters MUST be turned in by the start of lifting on Saturday. Trophies for 1st thru 3rd for Powerlifting, Bench Press Only and Power Sports Teams. Maximum of 10 members per team.

I realize this Competition is an Anabolic Steroid Free Meet and I MAY be Tested by Urinalysis

$40.00 per Team Entry. This fee is for the Team Trophy. Team Rosters MUST be turned in by the start of lifting on Saturday. Trophies for 1^st thru 3^rd for Powerlifting, Bench Press Only and Power Sports Teams. Maximum of 10 members per team.