North Carolina Powerlifting

Late Fee Begins 6-30-08 NO Credit Card Entries After 6-30-08

   NASA Arizona State Credit Card Entry Form Only

    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 Additional Entries-

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 Powerlifting, the Ramada Hotel, the facility used and any 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 I am responsible for all attempts I select in the warm-up room and during the meet. I am responsible for having adiquate spotters and loaders in the warm-up room at all times. 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 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 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
I to the terms of this waiver (Initials)-

Lifting will begin at both days at 10:00 am

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 Equipped & Unequipped Powerlifting & Bench Press Only

$60.00 for first division entered, $35.00 for each additional entry. Late Fee after Deadline Date is $5.00 additional fee for first division entered. All High School Entries- $35.00 per division entered. Cash Only for all late entries

“Power Sports” Raw, Totally Unequipped - Full Meet (Curl+BP+DL=Total) Entry Fee’s

Power Sports INDIVIDUAL Events - Entry Fee - Awards in Each Individual Event Entered

Strict Curl Only= $50

Bench Only=$50.00

Deadlift Only= $50.00

Team Entry Fee

$35.00 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