Iowa Powerlifting

Late Fee Begins 4-16-12

  NASA Iowa State Entry Form Only - Late Fee's Begin 4-16-12

    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 Bench Press (wraps & belt only) - ,

Unequipped Powerlifting Divisions Entered- , ,

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

  Push Pull Divisions Entered (i.e. Pure, Open, M-1 etc)- ,

    Grand Total Number of Divisions Entering-

    Total to Paid via PayPal below -$   (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

Do Not Sign This Waiver Before Reading It Fully and Carefully. If you do not understand and accept it’s terms DO NOT Sign It.

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, the facility used, Des Moines Strength Institute, Dale Rhoades, their staff 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 agree that my name may be published if I fail any NASA Urine Test. I also understand and agree to the rules of this meet and the Rules of NASA. I also know and understand NASA's drug testing procedures, the use of the NASA Coefficient System and I know and understand the NASA Banned Substance List. I do hereby verify my acceptance of these terms by my signature below and my Credit Card information above. 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.

No Refunds on No Shows

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-

STEP 2 - Pay
PayPal Iowa State Credit Card Entry - Secured

Be sure and submit the form above to complete your entry

Entry Fee's

Divisions I Am Entering

Do Not Sign This Waiver Before Reading It Fully and Carefully. If you do not understand and accept it’s terms DO NOT Sign It.

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

Official Weigh-In Times

Men’s Weight Classes

Women’s Weight Classes

“Power Sports” Raw, Totally Unequipped - 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

Entry Fee’s - Equipped / Unequipped Powerlifting, Push Pull & Equipped / Unequipped Bench Only

Return Entry and Entry Fee’s

NASA LLC, P.O. Box 735, Noble, OK. 73068

Team Entry Fee