The 2002 USAPL Pennsylvania State Championships
April 6th - 7th, 2002
Official Entry Form
LATE ENTRY DEADLINE MARCH 31ST!!!
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Age:________  Date of Birth_____/_____/_____
Wt. Class________  Sex_________ 
Name:_____________________________________________

Address: Street_____________________________________
City________________________________________
State_____ ZIP__________ 

Phone (______)______________________
USAPL Card # _________________
EMAIL_________________________
 

Check All Divisions entered: 
Male Female
Open  ___  ___
HS ___ ___
Teenage ___ ___
Collegiate ___ ___
Master 1 (40-49) ___ ___
Master 2 (50-59) ___ ___
Master 3 (60-69) ___ ___
Master 4 (70-79) ___ ___
Junior(20-23) ___ ___
Special Olympian ___ ___
Out of State ___ ___
*Non-Pennsylvania "Open" Lifters should enter the Out of State
(Not including Jr, Teen, Master, Jr., Special Olympian, HS)

Release from Liability Read this carefully.
When you sign it you will be giving up important legal rights.

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.
 
 
_______________________
Signature of Contestant
__________________________
Signature of Parent or Legal Guardian 
if the contestant is under 21 years of age

 
 ENTRY FEE: HS/Teenage, Special Olympian $30, Open $60.00 for the first division, $20.00 each additional division.
ENTRY DEADLINE MARCH 18TH!!!

Late entry fee $70 for the first division, $30 each additional division.. No entries accepted past March 31st!!! Limit to 150 entries, 75 per day!!

Mail Entry Form & Fee to: 
Joe Luciano
706 N. Blakely St.
Dunmore, Pa 18512
Home # 570-961-0915
Work # 570-342-8115

Contest Sponsors:

Bob O'Leary Sports Science - BOSS 
701 Keyser Ave. 
PO Box 79 
Scranton, PA 18504
Phone: (570)342-4984 
Fax: (570)342-1368 
Toll Free: (800)666-8870 
 
 


http://www.bossonline.net/


 


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