NASA Generic Entry Form

Print, Complete and Mail with Fee's to: NASA Entry, PO Box 735, Noble, OK. 73068

or to the Appropriate NASA Meet Director. See individual Entry Form for Meet Director's address.

Name of Meet-_____________________________  Date-_____  State-___

Name:________________________________  Weight Class:____  Age:___

Address:___________________ City:_______________ St:___  Zip:______

E-mail Address:________________________  Phone: (____)___________

Spaces are for the "Division of the Event" you are entering. I.E.- Pure, Open, Teen, M-1, etc

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

Full Unequipped Powerlifting: _____, _____, _____, _____

Unequipped Bench Press: _____, _____, _____, _____

Bench Press Only (equipment allowed):_____, _____, ______, ______

Power Sports© (raw) Full Meet Divisions Only- _____, ______, ______

Power Sports© Individual Events Only-  _____, ______, ______, ____

Push Pull Events Only- - _____, ______, ______, ______

Late Fee if after Deadline Date- $________

Total Amount Enclosed : $_______  Check #_____ 

Total Number of Divisions Entered:____

To enter by Credit Card/Pay Pal use Entry Form on the Web Site for the meet you choose to enter.

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, Gallup High School & the Gallup school district, 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 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.

Athlete’s Signature:_____________________________________   Date:__________

Parent’s Signature if Athlete is under 18 years of age:_______________________  Date:_____

Print, Complete and Mail with Fee's to: NASA Entry, PO Box 735, Noble, OK. 73068