West TX Powerlifting Entry

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

Official Weigh-In Times

Lifting will begin at 10:00 am Saturday

Rules: All Current NASA Rules will apply. View the entire NASA Rule Book on our Web Site at www.nasa-sports.com. NASA Membership Cards are required for this meet. Adult Cards $30.00 & High School Lifters are $15.00 per year. All lifters MUST wear a Wrestling Suit or other one piece suit. Canvas Shirts Illegal.

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.

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

"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.

Powerlifting, Push Pull and Equipped BP: Single Ply Suits, BP Shirts and Wraps are allowed.

Unequipped Powerlifting: Wrist Wraps, Knee Wraps and Belt allowed. No Suits and/or BP Shirts allowed.

Power Sports©: No Supportive Equipment is allowed except a 4" wide lifting belt.

Men’s Weight Classes

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

Women’s Weight Class

Police & Fire: Any Full Time Police & Fire Personnel, Lifetime Anabolic Steroid Free.

Sub-Masters-1: 30-34 years of age, Anabolic Steroid Free for minimum 3 years.

Sub-Masters-2: 30-34 years of age, Anabolic Steroid Free for minimum 3 years.

Masters Pure: 40+ years of age, Lifetime Anabolic Steroid Free lifters only.

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 Column Trophies, Extra Large Plaques and Large Plaques.

Return Entry and Entry Fee’s

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

Entry Fee’s Powerlifting, Push Pull & BP Only (equiped)

Powerlifting & BP Only: $50.00 for first division entered, $30.00 for each additional entry. Late Fee after Deadline Date is $5.00 additional fee, on first division entered Only. Cash Only for all late entries. High School Entries are $40.00 pre-entered, $45.00 Late.

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

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

Strict Curl Only= $50.00

Power Sports Bench Only=$50.00

Power Sports Deadlift Only= $50.00

Combination of Any Two Power Sports Events (2 Total Divisions, 2 Awards) = $80.00

Team Entry Fee

$35.00 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.

Name:________________________ Weight Class:______ Age:_____

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

Unequipped BP (wraps and belt only) Divisions Eneterd: _____, _____, _____, _____

Power Sports (curl, bp & dl) Full Meet Divisions Only- _____, ______, ______, ______

Power Sports Individual Divisions & Events (curl, BP, DL): _____, _____, _____, _____

Total Enclosed : $_______ Check #_______ Total Number of Divisions Entered:____

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 LLC Powerlifting, the facility used, Hereford YMCA 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 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.

Parent’s Signature if Athlete is under 18 years of age:____________________________ Date:________

E-mail this Credit Card Form Now - Late Fee Begins 11-29-10

   NASA West Texas Regional Credit Card Entry Form Only

Late Fee's Begin 11.29.10 - Any Entries Received After Late Fee's Begin Will Be Charged A Late Fee Automatically

Or You May Enter by PayPal Here

  First Name-    Last Name-

  Wt. Class-   Age-   DOB-    Phone-

   Address- City-

   State- Zip-        E-mail Address-

    Powerlifting Division(s) Entered -, ,

   Unequipped Powerlifting Division(s) Entered -, ,

   Bench Only Division(s) Equipped Entered -, ,

Unequipped Bench Press Only- , ,

   Power Sports Full Meet (curl, BP & dl) Division(s) Entered -, , ,

   Power Sports Individual Events & Divisions Entered ( curl, bp, dl only)- , , ,

   Push Pull Divisions Entered- ,

    Total Number of Divisions Entering-

    Total being paid by PayPal or call-in Credit Card -$

I will be paying by the following method -

Submit this form first and THEN either Call-In your Credit Card Number or Pay by PayPal below (Step 2)

Comments-

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 AL L CLAIMS FOR INJURY OR DAMAGES WHICH I MAY INCUR BY VIRTUE OF MY COMPETING IN THIS MEET AS AGAINST RICH PETERS, N.A.S.A., Hereford YMCA, AND ALL OF THEIR AGENTS AND EMPLOYEE'S . I ALSO REALIZE THAT THE SPORT OF POWERLIFTING IS A HIGH RISK SPORT AND I COULD BE SERIOUSLY INJURED. I ALSO REALIZE I AM RESPONSIBLE FOR MY OWN SAFETY WHILE USING THE WARM-UP AREA. I CERTIFY THAT I AM IN GOOD HEALTH AND HAVE NO SERIOUS HEALTH PROBLEMS AND ASSUME FULL RESPONSIBILITY FOR SUCH CONDITIONS. I HAVE READ AND FULLY UNDERSTAND THIS WAIVER AND ASSUME ALL RISKS FOR INJURY, AND DO HEREBY VERIFY MY ACCEPTANCE OF THIS WAIVER BY MY SIGNATURE OR INITIALS. DO NOT SIGN BEFORE READING THIS DOCUMENT FULLY AND CAREFULLY. I agree to the terms of this waiver and do so indicate by my submission this Credit Card Entry.

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 LLC Powerlifting, NASA, the Hereford YMCA, 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 realize that if I use the False Grip or Open Grip that it is a dangerous method of BP'ing and I assume full responsibility if I choose to use this method to BP. I also agree to submit to drug testing at any time during this event if I am asked to do so. I certify that I know and understand completely the NASA policy for drug testing and NASA's use of it's coefficient system and agree to their policies.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. I also realize that children and non lifters are NOT allowed in the warm-up room for any reason. I also give NASA, Rich Peters and all other parties involved in this meet permission to post my name and make my name public if I fail any Drug Test.

I Realize that this Competition is an Anabolic Steroid Free Meet
I to the terms of this waiver (Initials)-

Security Word - nasa101

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STEP - 2
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Pay Your Entry Fee's By Credit Card or E-Check NOW

Entry Fee's

Enter All Divisions You Are Entering - Be Specific, i.e. Masters

Official Weigh-In Times

Lifting will begin at 10:00 am Saturday

Men’s Weight Classes

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

Women’s Weight Class

Return Entry and Entry Fee’s

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

Entry Fee’s Powerlifting, Push Pull & BP Only (equiped)

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

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

Strict Curl Only= $50.00

Power Sports Bench Only=$50.00

Power Sports Deadlift Only= $50.00

Team Entry Fee

$35.00 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 1st thru 3rd for Powerlifting, Bench Press Only and Power Sports Teams. Maximum of 10 members per team.

Name:________________________ Weight Class:______ Age:_____

$35.00 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.

Name:__________________ Weight Class: Age:_