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Championship Meet,"
January 20th, 2007
Green Bay, WI.
(Late Fees Begin
January 14th, 2007).
Name:_________________________________
Weight Class___________ Age:___________
Address:_______________________________
City:__________________________________
State:________________ Zip:______________
e-Mail Address:_________________________
Phone: (_______)________________________
Full Powerlifting(Only) Meet Divisions Entered:
_________,_________,_________,_________
Full Power Sports(Only) Divisions Entered:
_________,_________,_________,_________
Push/Pull(BP+DL) Divisions Entered:
_________,_________,_________,_________
Individual Lift(Crl,SQ,BP,DL) Divisions Entered:
_________,_________,_________,_________
Total Amount Enclosed: $____________
Check #_______ Total # of Divisions:______
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, the facility
used, and any of their agents and 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 warm-up 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, and also permission
to make my name public if I fail any Drug Test.
I understand that in Meets where the Squat is an Event, that the Awards(Trophy)
Ceremony will not begin until the Amerilift(Monolift) Base has been loaded on the truck.
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, Parent Sign Below)
Parent's Signature_________________________________
Make Checks or Money Orders Out to:
"Wisconsin Powerlifting"
Mail Completed Application(Both Pages) To:
Job Hou-Seye, State Chairman
Wisconsin Powerlifting
222 Prospect Avenue
Sheboygan, WI 53081
Job/Wendy can be contacted by calling: 920-254-6041.
(If they are not there, please leave a message/number).
If you do not have a printer, send a self-addressed,
stamped envelope, to the above address, and we will
send you a blank meet application.
Divisions & Fees
1st Push/Pull Entry
$55 Adult/$40(13-17) $30(5-12)
1st Individual Lift Entry(BP, Etc.)
$45Adult/$35(13-17) $25(5-12)
All Additional Entries & Divisions
$25
Example: Push/Pull + BP = $80
Example: BP + BP = $70
Example: SQ + DL = $70
Example: BP = $45
N.A.S.A. Cards Available at the Meet or at N.A.S.A. Website,
(Adults, $30; Teen, $15)
Weigh-in 7:00 P.M. to 8:00 P.M., Friday, January 19th, 2007.
Weigh-in 8:00 A.M. to 9:00 A.M., Saturday, January 20th, 2007.
Lifting Will Begin at 10:00 A.M., Saturday, January 20th, 2007.
All "Single Ply" Lifting Suits Are Legal. Shirts must be whole from Collar to
Waistline, effective 1/1/2007.
Only a Belt and Singlet Are Allowed for Power Sports(+ T's for Ladies)
Canvas Material Disallowed.
Men's Weight Classes
114,123,132,148,165,181,198,220,242,275,308,SHW
Women's Weight Classes
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 to 12
TEEN - 13 to 19
OPEN - ALL AGES
SUBMASTER 1 - 30 to 34
SUBMASTER 2 - 35 to 39
SUBMASTER PURE - 30 to 39(Must Be Lifetime Pure)
MASTERS 1 - 40 to 49
MASTERS 2 - 50 to 59
MASTERS 3 - 60 to 69
MASTERS 4 - 70+
MASTERS PURE - 40+(Must Be Lifetime Pure)
NOVICE - No National Championships
ALL DIVISIONS AVAILABLE IN BOTH PURE(LIFETIME) AND NATURAL(36+
MONTHS CLEAN), UNLESS NOTED.
Go To: www.nasa-sports.com to view the NASA Rule Book.
Meet Site: 321 S. Washington Street, Green Bay, WI, 54301
Quality Inn Hotel, Green Bay., 321 S. Washington Street, Green Bay, WI, 54301
Reservations: 1-800-252-2952.
http://www.qualityinngreenbay.com/