World Cup Powerlifting NASA Entry

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PL'ing, BP & DL Credit Card Entry Form Late Fee Begins on July 29th, 2013

STEP-1 Entry Info

Complete Entry Form and click "Submit" then proceed to STEP 2 if paying by PayPal

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~ NOTE ~

Late Fee starting 8-06-12 is $10.00 additional fee for the First Division Entered!

Please Accept My Entry For the 2012 World Cup

First Name- Last Name-

Wt. Class- Age- DOB- Phone-

   Address- City-

   State- Zip-   E-Mail-
   Equipped Powerlifting Division(s) Entered-, , ,

    Unequipped Powerlifting Division(s) Entered-, , ,

    Equipped Bench Only Division(s) Entered-, ,

    Unequipped Bench Only Division(s) Entered-, ,

    Power Sports Full Meet Division(s) Entered -, , ,

    Power Sports Individual Lift Division(s) Entered -, , ,

    Push Pull Division(s) Entered (fill in)-, , ,

    UNEQUIPPED Push Pull Division(s) Entered -, , ,

   Youth Division(fill in which events)-, , ,

    NEW - Power Press (fill in which DIVISION(s))-, , ,

   NEW - Masters Evolution Division(s))-, , ,

     NEW - ????? Division(fill in which DIVISION(s))-, , ,

    Grand Total Number of Divisions Entering-

You Will Be Charged A $10.00 Late Fee For The First Division You Enter After 7.29.13

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 and Do Not Enter This Meet.

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, Wyndham Gardens Hotel and 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 and attending 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's Coefficient System as a part of NASA's Drug Testing protocol and I know and understand the NASA Banned Substance List. If I am a parent with children in this meet I assume full responsibility for them at this meet whether they are lifting or not. I also agree to forfeit my entry fee and NASA Membership if I am attempting to enter this meet while under suspension by any other accredited PL Federation. I do hereby verify my acceptance of these terms by my signature below (Initials) 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.

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-

Now Go To Step 2 for Payment Of Your Entry

Official Weigh-In Times

Women’s Weight Classes

Power Sports© Entry Fee’s

Entry Fee’s - Equipped & Unequipped Powerlifting, Bench Only Equipped & Unequipped and Equipped & Unequipped Push Pull, Power Press

Return Entry and Entry Fee’s

Team Entry Fees

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 and Do Not Enter This Meet.

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