Arizona State Powerlifting

Equipped and Unequipped Powerlifting, Bench Press Only, Push Pull & Power Sports Championship

Hotel Info: Best Western Mezona, 250 W. Main St.. Mesa, AZ. 1-800-528-8299 Meet Headquarters!!! Special reduced rates for Lifters & Spectators. Please support this meet sponsor. No other Hotel sponsors NASA and your business is wasted elsewhere.

Meet Director: Rich Peters, P.O. Box 735, Noble, OK. 405-527-8513 sqbpdl@aol.com

Lifting will begin at 10:00 am Saturday

Rules: All Current NASA Rules will apply. See the NASA Rule Book on our Web Site at www.nasa-sports.com. NASA Membership Cards are required for this meet. Adult Cards $30.00 and Senior Lifters (65+ years old) & High School are $15.00 per year. All lifters MUST wear a Wrestling Suit or other one piece suit. All lifters MUST wear Knee High Socks during the Deadlift.

"Power Sports" Lifters: Required to do Strict Curl, Bench Press and Deadlift in the Full Meet. Lifters may enter any event individually. No Supportive Equipment is Allowed except a 4” Lifting Belt. One piece Lifting Suits MUST be worn. You may enter any event as a single lift event, i.e.-Curl, BP, Squat, DL or Full meet in any division(s) you are qualified, i.e. Masters-1, Novice, Pure, Open, etc.

"Powerlifting" Lifters: May use any single ply Suits, Bench Shirts, Legal Wraps for Squat, Bench Press and Deadlift. All Canvas Shirts & Suits are Illegal as of 3-1-01.

"Unequipped Powerlifting" Lifters: May use a 4" wide lifting belt and wrist and knee wraps only. Consists of Squat, Bench press and Deadlift.

"Bench Only" Lifters: May use single ply Bench Press Shirts, Legal Wrist Wraps and Belt. No Canvas

"Push Pull" Lifters: Consists of the Total of your best BP and DL. May use single ply equipment and wraps.

Power Sports Lifters: Required to do Strict Curl, Bench Press and Deadlift. No Supportive Equipment is Allowed except a 4” Lifting Belt. One piece Lifting Suits MUST be worn. You may enter any event as a single lift event, i.e.-Curl, BP, Squat, DL or Full meet.

Powerlifting Lifters, Push Pull & Bench Press Only Lifters: May use any single ply Suits, Bench Shirts, Legal Wraps for Squat, Bench Press and Deadlift. All Canvas Shirts & Suits are Illegal as of 3-1-01

Bench Only Lifters: May use single ply Bench Press Shirts, Legal Wrist Wraps and Belt.

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

Women’s Weight Class

Awards: 1^st thru 5^th Place Awards for each weight class in each Division for Powerlifting and Power Sports Contests. Awards will consist of 2, 3 & 4 Column Trophies, Extra Large Plaques, Large Plaques.

Return Entry and Entry Fee’s

How To Enter - Using The Entry Form Properly

$60.00 for first division entered, $30.00 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 Entries are $40.00.

Entry Fee’s: “Power Sports” Raw, Totally Unequipped - Full Meet

Full Meet (Curl, BP & DL) = $60.00 first division, $30.00 for each additional PS Division entered.

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

Strict Curl Only= $60.00 first division, $30.00 for each additional single lift PS division entered

Power Sports Bench Only=$60.00, $30.00 for each additional single lift PS division entered

Deadlift Only= $60.00, $30.00 for each additional single lift PS division entered

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.

Arizona State Powerlifting Championships Late Fee Begins: January 30th, 2012

Name:________________________________ Weight Class:________ Age:_____

Address-_______________________________ City-__________________________

State-___ Zip-_______ Email Address:___________________________ Phone: (____)____________

Equipped Full Powerlifting Meet Divisions Entered: _____, _____, _____, _____

Unequipped Full Powerlifting Meet Divisions Entered: _____, _____, _____, _____

Unequipped BP (wraps & belt only allowed): _____, _____, _____, _____

Equipped Bench Press Only (equipment allowed):_____, _____, ______, ______, ______

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

Power Sports (raw) Individual Lift Divisions Only (Curl, BP or DL)- _____, ______, ______, ______,

Push Pull Divisions Entered- _____, ______, ______, ______

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

Please add my NASA Membership Fee to my Total - Adult $30.00 High School $15.00

If entering with a NASA Gold Card, you MUST send card with entry form

Credit Card - Visa____ Master Card____ American Express___ Discover____

Card #-______ ______ ______ _____ Expires-______ Name on Card-(print) ______________________ Total to Charge- $_______

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

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, Westwood High School, 945 West 8th St., Mesa, AZ. , including but not limited to 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 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. Do Not Sign This Waiver Before Reading It Fully and Carefully. If you do not accept it’s terms, DO NOT sign it.

Athlete’s Signature:_________________________ Date:__________

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