E Texas Powerlifting Entries

Late Fee Begins 6.14.11 No Credit Card Entries After 6.14.11 Without Late Fee Included

STEP 1 - Complete Entry Form

NASA East Texas Open Secure PayPal 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 Amount of Entries- $ (Don't forget to pay by PayPal below the Submit Button or call in your Credit Card info)

    You MUST submit this entry along with the PayPal Payment below to be entered in this meet. To pay by Credit Card without PayPal you must submit this entry form and then call 1-405-527-8513 to give credit card info by phone.

Comments or Questions-

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

I realize this is a Anabolic Steroid Free Meet and I MAY be Urine Tested

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, Quality Hotel, NASA LLC Powerlifting, 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 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 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 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)-

I will be paying by the following method -

Security Word - nasa101

Please type Security Word, nasa101, here-

After you submit the Entry Form, please pay below (Step-2) - Entry is Incomplete until you pay.

STEP 2 - Pay Entry Fee
Pay Now - PayPal Credit Card Entry - Secured

Number of Entries

Official Weigh-In Times

Lifting will begin at 10:00 am Saturday

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, $30.00 for each additional entry. Late Fee after Deadline Date is $5.00 additional fee for first division entered. All High School Entries- $45.00 per division entered. Cash Only for all late entries

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

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

Strict Curl Only= $60.00

Bench Only=$60.00

Deadlift Only= $60.00

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