Masters Powerlifting

Late Fee Begins 11-3-08 NO Credit Card Entries After 11-3-08

   NASA Masters / Sub Masters Credit Card Entry Form Only

    First Name-    Last Name-

    Wt. Class-   Age-   DOB-     Phone-

   Address- City-

   State- Zip-        E-mail Address-

    Powerlifting Division(s) Entered (i.e. 40-44, etc)-,

     Experimental HRT Program-     In which portion of the meet? (PL'ing, BP Only, PP, PS)

     Unequipped Powerlifting Divisions Entered - ,

    Bench Only Division(s) Entered (i.e. 40-44, etc)-,

    Unequipped Bench Press Divisions Entered- ,

    Power Sports© Full Meet Division(s) Entered (i.e. 45-49, 55-59, etc) -,

    Power Sports© Individual Events entered- (c-40-44, bpsmp, etc)- , ,

     Push Pull Divisions Entered (i.e. m-p, 50-54, etc)- ,

    Grand Total Number of Divisions Entering-

    Late Fee will be added to all Late Entries!

    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

I realize this is a Anabilic Steroid Free Meet and I MAY be Urine Tested at any time during this event

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 Wwestwood 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.

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 the waiver posted above and on the written entry form and do so indicate by my submission this Credit Card Entry.

I Realize that this Competition is an Anabolic Steroid Free Meet
I to the terms of this waiver (Initials)-

Official Weigh-In Times for All Lifters

Men’s Weight Classes

Women’s Weight Classes

Men’s & Women’s Age Divisions for Powerlifting, Bench Press Only (equipment allowed), Push Pull (equipment allowed), Power Sports (raw)

*Sub Masters Pure: 30-39 of age, Anabolic Steroid Free for Life.

*Masters Pure: 40+ years of age, Anabolic Steroid Free for Life.

Power Sports© (no equipment) Entry Fee’s Only - Use Credit Card Form below for ALL Power Sports© Entries.

Entry Fee’s - Use Credit Card Form below for ALL Masters Entries.

Return Entry and Entry Fee’s : NASA LLC, P.O. Box 735, Noble, OK. 73068 Or you may enter on-line from our web site.

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, BP Only and Power Sports Teams. Maximum of 10 members per team.

Name:____________________ Weight Class: Age:_

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