Georgia Powerlifting

STEP 1
Complete Entry Form and Submit
Steps 1 and 2 MUST be completed for Entry to be complete

   NASA Georgia State PayPal Credit Card Entry Form Only - Late Fee's Begin 3-26-12

    First Name-    Last Name-

    Wt. Class-   Age-   DOB-     Phone-

   Address- City-

   State- Zip-        E-mail Address-

  Equipped Powerlifting Division(s) Entered (i.e. Pure, Open, M-1 etc)-,

Equipped Bench Only Division(s) Entered (i.e. Pure, Open, M-1 etc) -,

Unequipped Powerlifting Divisions Entered- , ,

Unequipped Bench Only Divisions Entered (i.e. Pure, Open, M-1 etc) - ,

  Power Sports© Full Meet Division(s) Entered (i.e. Pure, Open, M-1 etc) - ,

Power Sports© Single Lift Events Entered (Curl, BP, DL) - , , ,

   Push Pull 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

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, Gold's Gym of Cartersville, GA, Charles Nixon, 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 -

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STEP - 2

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Bench Press Only, Push Pull & Power Sports© Championships

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

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