2010 Chippewa Classic
Saturday, May 1st, 2010
McDonell Central Catholic High School
1316 Bel Air Boulevard
Chippewa Falls, WI, 54729
N.AS.A.
(Late Fees Begin on Applications Post-Marked After April 21st, 2010)
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. I UNDERSTAND THAT THE AWARDS CEREMONY WILL NOT BEGIN UNTIL THE MONOLIFT BASE HAS BEEN LOADED BACK ON THE MEET DIRECTOR’S TRUCK OR TRAILER.
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
- 888 - J0B - H0USEYE(1 - 888 - 502 - 4087)PAGE 2 OF 2
2010 Chippewa Classic Meet Fees
And Hotel Information
Entry Fees
1st Quadralifting© Entry—$40(21 & Older Only)
1st Unequipped Powerlifting, Power Sports, Unequipped Push/Pull, or Unequipped Bench Only Entry - $50 Adult - $40(13-17) - $30(5-12)
1st Equipped Powerlifting, Benchpress or Push/Pull Entr - $60 Adult - $45(13-17)
All Additional Entries & Divisions - $30[Call Job about Discounts]
Receive a $20 Discount on First Entry by having Job quote your auto insurance.
Job’s existing clients get a $10 discount on their First Division Entry Fee.
N.A.S.A. Cards available at the Meet(Adults, $30; Teens, $15; Youth, $10)
Friday Night Weigh-in: 6:00 PM to 7:00 PM
Annual Wisconsin Banquet is at 7:30 PM at the Fill Inn Station, 104 W. Columbia: Adults $20
Saturday Morning Weigh-in: 7:30 AM to 8:30 AM
Lifting will begin at 9:30 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 Availablefor 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
Hotel Information
Avalon Hotel & Conference Center, 1009 West Park Avenue, Chippewa Falls, WI, 54729.
Group Rate is $74 Per Night - Ask for NASA-YMCA Regional Powerlifting Competition for Group Rate.
Must call 1-888-727-5288 by or before March 31st to be guaranteed the NASA Group Rate.
www.avalonhotelchippewafalls.com
