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 lifing 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: 1-920-918-9475   $_____ Entry Fees _____ Other _____ Contribution to High School Scholarship Fund($5, $25, $50, $100, Other) $_____ TOTAL ENCLOSED 

Job Hou-Seye Wisconsin Powerlifting P.O. Box 565 Sheboygan, WI, 53082

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