2016 Wisconsin Regional Meet
Saturday, May 8th, 2016
SHEBOYGAN YMCA
812 Broughton Drive
Sheboygan, WI,
N.AS.A.
(Late Fees Begin on Applications Post-Marked After April 27TH, 2016)
Name
- ____________________________________________________________Weight Class__________ Age___________ Phone _(_____)_______________
Address____________________________ State_______ Zip______________
e
- Mail Adress______________________________________________________Quadralifting© (Curl + Squat + Bench + Deadlift: Must be 21+) Divisions:
____________ ______________ _________ ___________
Mens Open(21-39) Mens Masters(40+) Ladies Open Ladies Masters
Equipped Powerlifting(Squat + Bench + Deadlift: Must be 13+) Divisions:
____________ ______________ ______________ _____________
Unequipped Powerlifting(Squat + Bench + Deadlift: Must be 13+) Divisions:
____________ ______________ ______________ _____________
Power Sports© (Curl + Bench + Deadlift: Must be 5+) Divisions:
____________ ______________ ______________ _____________
Push/Pull (Bench + Deadlift: Must be 5+) Divisions:
____________ ______________ ______________ _____________
Bench Only & Unequipped Bench Only Divisions:
____________ ______________ ______________ _____________
(PAGE 1 OF 2)
Official Meet Entry Form
Check#_____ Amount $_____
I realize this Competition is an Anabolic Steroid Free Meet and I may be Tested by Urinalysis. I have not used Anabolic Steroids in the last 36 Months, and I have not used diuretics or psychomotor stimulants in the last 10 days.
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 competing in this contest as against Rich Peters, NASA LLC Powerlifting, Job Hou-Seye, the facility used, and any of their agents or 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 Benchpressing, and I assume full responsibility if I choose to use this method to Benchpress. I also realize that I am fully responsible for my well-being and safety in the warmup 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 its terms. I do hereby verify my acceptance by my signature below. I also give NASA, Rich Peters, Job Hou-Seye, and all other parties involved in this meet permission to post my name, photos taken at the meet, and also permission to make my name public if I fail any Drug Test. I understand that the Entry Fees cover the cost of trophies, drug tests, other Administrative Costs, and that they include sales tax in the State of Wisconsin.
DO NOT SIGN THIS WAIVER BEFORE READING IT FULLY AND CAREFULLY. IF YOU DO NOT ACCEPT ITS TERMS, DO NOT SIGN IT.
Athlete’s Signature________________________________________
Date:_______________(If under 18, Legal Guardian Sign Below)
Parent’s Signature_________________________________________
Make Checks or Money Orders out to: "Wisconsin Powerlifting"
Mail Completed Applications(both sides) to: Job Hou
- SeyeWisconsin Powerlifting
P.O. Box 565
Sheboygan, WI, 53082
Call Job at: 1
-920-918-9475PAGE 2 OF 2
2016 Wisconsin Regional Meet Fees
Entry Fees
1st Quadralifting© Entry—$40(21 & Older Only)
1st Unequipped Powerlifting, Power Sports, Unequipped Push/Pull, or Unequipped Bench Only Entry - $60 Adult - $45(13-17) - $30(5-12)
1st Equipped Powerlifting, Benchpress or Push/Pull Entr - $55 Adult - $45(13-17)
All Additional Entries & Divisions - $30[Call Job about Discounts]
A $15 Late Fee applies to Entries not postmarked by April 27th, 2016.
N.A.S.A. Cards available at the Meet(Adults, $40; Teens, $15; Youth, $10)
Friday Night Weigh-in: 6:00 PM to 7:00 PM -
Ends at 7PM SHARP due to Banquet at 7:30
Saturday Morning Weigh-in: 8:00 AM to 9:00 AM
Lifting will begin at 10:00 AM: Rules Meeting at 9 AM.
All Single Ply Lifting Suits are Legal.
No Open Back or Velcro Bench Shirts. Shirts MUST BE Whole at Collar.
Only a Belt & Singlet are allowed for Power Sports.
T-Shirts required for Squat & Benchpress. Canvas & Denim materials disallowed.
Knee socks required on Deadlift(No Exceptions, effective 1/1/2009).
MENS - 114, 123, 132, 148, 165, 181, 198, 220, 242, 275, 308, SHW
LADIES - 97, 105, 114, 123, 132, 148, 165, 181, 198, 198+
Weight Classes Available for All Divisions
ALL DIVISIONS EXIST FOR BOTH MEN AND WOMEN
YOUTH 5-12; TEEN 13-19; OPEN(ANY AGE); SUBMASTER 30-39
MASTERS 1(40-49); MASTERS 2(50-59); MASTERS 3(60-69)
MASTERS 4(70+); MASTERS 5(PURE; 40+ & LIFETIME DRUG FREE)
Go to www.nasa-sports.com to view the NASA Rule Book