2002 USAPL
PA Ironman / Ironwoman Championships
Official Entry Form
October 12th, 2002
Entry Deadline: October 7th, 2002
Name:________________________________
Age:_______ Date of Birth:________
Weight class:________ Sex:______
USAPL Card # ________ or I will buy at weigh-in_____
Address: Street________________________
City:________________________________
State: _________ Zip:_______________
Phone: (___)________________
E-mail:_____________________
| Check all divisions you are entering |
MEN |
WOMEN |
| Open |
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| Teenage |
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| Master |
____ |
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| Junior |
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| Special Olympian |
____ |
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| Handicapped |
____ |
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RELEASE FROM LIABILITY
(Read this carefully)
In consideration of the acceptance of my entry form in this powerlifting
competition I intend to be legally bound, for not only myself but also
for my heirs, my executors and my administrators. In signing this release
from liability I waive and release everyone connected with this competition
from any and all liability, including any result of negligence, which may
arise from this competition. Moreover, I agree that any testing method
which the meet director and the sponsors of this meet use to detect the
presence of strength inducing drugs SHALL BE CONCLUSIVE. This is, whether
I think the results of the test are right or wrong, I agree that I have
no right to challenge the results of the drug tests. I further agree to
submit to any physical test, which may be necessary to complete the drug
testing. Should I fail to pass the drug tests I agree to forfeit any trophy
or award, which I might otherwise have won. I understand and agree that
if I fail to pass the drug tests, my name will appear on a published list
of suspended members. f it is determined that I have failed the drug test,
I agree to waive any claim for which legal relief is available. I agree
to pay any attorney fee and litigation expenses by any person, real or
corporate, whom I may sue in an effort to challenge this release from liability
form. I understand that my agreement to pay attorney fees and litigation
expenses is the SINE QUA NON for acceptance of my entry in this contest.
If any provision of this Release from Liability shall be deemed by a court
of competent jurisdiction to be invalid, the remainder of this Release
from Liability shall remain in force and effect. I also certify with my
signature that this release/agreement cannot be modified orally.
_____________________________
Lifters Signature
(date) |
__________________________________
Signature of parent or guardian If under 18
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Mail Entries to and Check to:
Make Check out to "Dennis Hulslander" |
Niko Hulslander
6 Church St.
Stewartstown, PA 17363
717-993-8000
Entry fees ...Single division = $40
Two or more = $55, Teen = $15, Team = $50
Entry Deadline: Sept 20th, 2002 |
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