NASA Entry Form

NASA Entry Form
Step - 1

I am Entering the Following Meet - Date Of Meet -

First Name-       Last Name- Wt. Class-

Address-       City-      State-     Zip-

E-mail Address-      Phone-

I am Entering the following Event(s)

1. , 2. , 3.

Divisions
I am Entering in each of the above Events, i.e. Pure Equipped PL, Novice PS, Teen Unequipped PL, etc-
Division, Event 1- , Division, Event 2- , Division, Event 3-

Total Number of Divisions I am Entering -       Total Amount I Owe -

I will call-in my Credit Card - I will be paying by PayPal now - This is a Gold Card Entry, I bring my Gold Card to the meet -

If paying by PayPal see Step 2 below AFTER submitting this Entry Form

Your Entry Is NOT complete until your Entry Fee's are paid in Full

By Submitting my Entry for this event and including my Initials I am certifying that I agree to the Terms and Agreements listed in this waiver. If I am under the age of 18 I realize my Parents MUST Submit this form.
Read this Waiver Completely Before Submitting - All Unsigned Entries Will Be Refused and Denied

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, The Host Site of this Event, NASA Powerlifting, 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 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 Initials below, that I have read this waiver and fully understand and accept it’s terms. I also understand that no children are allowed in the warm-up room. I also agree to submit to Urine Testing if I am selected by the meet director for such testing. I do hereby verify my acceptance of these terms by my agreement below. Do Not Agree to This Waiver Before Reading It Fully and Carefully. If you do not accept it’s terms, DO NOT sign (initial) 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 Hereby

I Agree to the Waiver Above by my Initials -
Please Enter This Security Code - nasa101 - In This Box-

Submit Your Entry Now