(Please fill out the
entire application)
Name
____________________________________________________ Nick name
__________________________
Address
________________________________________________________ City
__________________________
State________
Zip Code _____________ Sex- M __ F __ Phone Number
_________________________________
Email
address
_________________________________________________________________________________
Wt.
Class _______________ Date of birth _______________ Age on meet day __________
Are
you a 2011-12 WNPF card holder? Yes__ No__ Card # _______ or card expiration
date ____ __1__ ____
Estimated
opening attempts- SQ ______ BP ______ DL ______ PC ______ (These can be changed
at weigh-ins)
Please
check event(s) and division(s) entering below……….
Full Power- Youth__ Teen__ Junior__
Open__ Subs__ Masters__ Police/Fire/Military__ Novice__ Raw__ Equipped__
Bench- Youth__ Teen__ Junior__ Open__
Subs__ Masters__ Police/Fire/Military__ Novice__ Raw__ Equipped__
Deadlift- Youth__ Teen__ Junior__ Open__ Subs__ Masters__
Police/Fire/Military__ Novice__ Raw__ Equipped__
Squat only- Youth__ Teen__ Junior__
Open__ Subs__ Masters__ Police/Fire/Military__ Novice__ Raw__ Equipped__
Ironman- Youth__ Teen__ Junior__ Open__
Subs__ Masters__ Police/Fire/Military__ Novice__ Raw__ Equipped__
Powercurl- Youth__ Teen__ Open__ Masters__
Reps- Teen__ Junior__ Open__ Subs__
Masters__ Police/Fire/Military__
Mail Entry
form and make payment to: Ron Deamicis
Send to: 6531 New Rd,
Youngstown, Oh 44515
Bank checks,
cash and money orders only. No personal checks accepted
Do not send
your entry form by certified mail, it will not be
picked up. If you want confirmation please email us.
Entry
deadline is April 21, 2012 Postmark, $30 late fee if sent in after this date,
$40 late fee if you are a walk-in lifter. Fees must and will be applied in
advance or at weigh-ins, no exceptions. Cash only at weigh-ins
In consideration of your accepting
this entry, I hereby for myself and my heirs, release any & all rights/claims
for damages for injuries I may have against the contest facility in use, World
Natural Powerlifting Federation, Troy Ford, Ron Deamcis, all other meet directors & staff, and any
& all other participating sponsors, supporters, referees, and spotter/loaders
as a result of my traveling to, and/or from and/or participating in, the above
listed competition. I make this release and waiver of claim with full knowledge
of the hazards and inherent rights associated with the above listed
competition. I hereby assume the risk of injury and property damage/loss. Also,
in consideration of your accepting this entry I hereby sign over my rights to
be videotaped and/or photographed to the meet directors and/or his designee. I
am fully aware that I will receive no royalties and/or compensation for
resale/use of the videotapes and/or photographs. I also realize that if I do
not attend this event for any reason I will forfeit all fees and cannot
transfer them to another event. In consideration of the acceptance of my entry
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 the competition from any and all liability, including
any results 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.
That is, whether I think results of the tests 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 tests which may be necessary to complete drug testing.
Should I fail to pass drug tests, I agree to forfeit any trophy or award which
I 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. If 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 incurred 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 the acceptance of my entry in this contest.
If any provision of this release form liability shall be deemed by a court of
competent jurisdiction to be invalid, the remainder of this Release of
Liability shall remain in full force and effect. I also certify with my
signature that this release/agreement cannot be modified orally. Certification: I hereby give my
word of honor as an athlete that I have not used any strength inducing drugs
(i.e. any anabolic steroid, natural hormone or synthetic growth hormone) as
part of my training during the past thirty six months, nor have I used
prescription diuretics or psychomotor stimulants during the seven days prior to
this meet.
__________________________Signature in full of applicant or Signature in
full of parent or guardian if lifter is under 18 Absolutely no
credit, refunds, exchanges or transfers on any and all fees!!!!!!!!!!
Meet Location: Black
Hawk High School 500 Blackhawk Dr, Beaver Pa
15010
Date: May 12, 2012
Times: Weigh-ins
6-7 pm on Friday and/or 8-9:30 am on Saturday, MANDATORY Rules briefing 9:45 am, Start time
9:45-10:30 am
Entry fee: $80
for one division and $60 for any additional division or event. Deadline is April 21, 2012 postmark.
A late charge will and must be applied if your app is not postmarked by the due
date. If you are going to be a walk-in you must call and have your name placed
on the roster otherwise you will not be able to lift. Check out the entry form
(page 2) for late fee amounts. Absolutely
no credit, refunds, exchanges or transfers on any and all fees!!!!!!!!!!
Team fee: $80.00 per team in
advance with a team roster. (Each lifter is required to pay the regular entry fee, this fee is to add your team into the Team competition.
The best teams in 2012 by point system will
receive Championship t-shirts and a LARGE championship trophy for the 2012
season.
Membership fee: $20
high school & special Olympics, $30 college students 19-23 yrs and seniors
over 65, all others $40. Memberships expire on the 1st day of the
month purchased in the following year. This member fee can be paid in advance
or at weigh-ins. Cash only at weigh-ins.
Equipment & Rules: Please
go to www.wnpf.net/rules.htm
for all equipment specifications and rules/regulations.
Awards: 1st
thru 5th place in each division and weight class. Best lifter awards
and team awards will be awarded.
Weight classes: Youth
girls (60, 80) Women (97, 105, 114, 123, 132, 148, 165, 181, SHW)- Youth boys (60, 80, 100) Men (114, 123, 132, 148, 165,
181, 198, 220, 242, 275, SHW)
Divsions: Youth 9-10, 11-12,
Teens 13-16, 17-19, Junior 20-23, Open, Subs 35-39, Masters in 10 year
increments and Novice. RAW-
Belt, Knee sleeves, Knee wraps, wrist wraps and a singlet. Elbow sleeves are
allowed in the squat and deadlift only. Equipped- 1 or 2 ply shirts
(poly, denim or open back) and up to a maximum of 2 plies (combo squat suit and
briefs), Wraps and a belt.
Records: State
records can be set at this event. Check out the records at www.wnpf.net/records/htm No 4th attempts in this
championship.
Events: Full
Power, Bench only, Deadlift only, Squat only, Powercurl, Reps & Ironman (Bench/Deadlift
for a total)
Admission: $5.00
per person at the door. Lifters PLEASE advise your cheering section and coaches
that there is a charge to see the show.
Attire sold: WNPF
meet shirts
Meet Director: Ron
Deamicis best way to reach me is by email at powerlt103@aol.com Phone # 330 519- 3078
Website: www.wnpf.net
for all information on the WNPF