ESPF
Official Eastern States Powerlifting Federation Entry Form
First Name _______________________ Last Name ___________________________
Address _____________________________________________ City __________________________ State _____________________ Zip __________
Nickname ___________________________________________
Phone _________________ Email _________________________________________
Gym Name ______________________________ State _______________
Wt.Class ________ Male _______ Female ______ DOB ___________ Age _______
Estimated opening attempts: SQ _______ BP ______ DL ______ (These can be changed during weigh-ins, these are only estimates)
Check Division(s) and Event(s) That You Want To Enter Below:
Full Powerlifting (SQ-BP-DL for a total)- Youth ____Teen ____ Junior ____Subs ____ Masters ____ Police/Fire/Military ____ Raw ____ Single Ply ____ Special O ____ Disabled ____ Open____
Bench Only- Youth ____ Teen ____ Junior ____ Subs ____ Masters ____ Police/Fire/Military ____ Raw ____ Single Ply ____ Special O ____ Disabled ____ Open___
Deadlift Only- Youth ____ Teen ____ Junior ____ Subs ____ Masters ____ Police/Fire/Military ____ Raw ____ Single Ply ____ Special O ____ Disabled ____Open___
Squat Only- Youth ____ Teen ____ Junior ____ Subs ____ Masters ____ Police/Fire/Military ____ Raw ____ Single Ply ____ Special O ____ Disabled ____ Open___
ALL FEES ARE NON-REFUNDABLE AND NON-TRANSFERABLE
Date: May 21st, 2011 Start time: 10 am Rules: 9:30-9:45 am sharp
Location: Atlas Fitness, 42 Nichols St., Spencerport, NY 14559
Weigh-ins: Friday 6-7 pm & Saturday 8-9:30 am (please bring equipment for inspection)
Entry Fee: $40 for 1st division or event, $20 for each additional division or event, after initial $100 each additional division is $10.
DEADLINE: All entries must be received by May15, 2011, otherwise a $10 late fee will be assessed. If you don't include it in your initial entry, you must pay it at weigh-ins. If you are going to be a late lifter, please email and have your name put on the roster.
NO REFUNDS OR TRANFERS OF FEES...
Make checks payable to: Patricia Unvericht and mail entry form and payment to: ESPF, c/o Patricia Unvericht, PO Box 303, Spencerport, NY 14559
Weight classes:
Men: 80, 90, 100,114, 123, 132, 148, 165, 181, 198,220, 242, 275 & SHW
Women: 80, 97, 105, 114, 123, 132, 148, 165, 181 & SHW
Divisions:
Youth 9-10 & 11-12, Teen 13-16 & 17-19, Junior 20-23, Subs 35-39, Masters in increments of 10 years, Police/Fire/Military, Special O, and Disabled.
Records:
ESPF New York and United States records can be set.
Awards:
Lifters through third place will be awards as long as they don't bomb out. Best Lifter and Team awards will be awarded too. Places will be determined once the meet is over.
Record Certificates will be given out after the meet.
Please check all the ESPF rules at www.espf.weebly.net
Admission:
No admission for spectators.
We are using pound plates.
Director: Patti Unvericht, [email protected] or 585-329-1723
First Name _______________________ Last Name ___________________________
Address _____________________________________________ City __________________________ State _____________________ Zip __________
Nickname ___________________________________________
Phone _________________ Email _________________________________________
Gym Name ______________________________ State _______________
Wt.Class ________ Male _______ Female ______ DOB ___________ Age _______
Estimated opening attempts: SQ _______ BP ______ DL ______ (These can be changed during weigh-ins, these are only estimates)
Check Division(s) and Event(s) That You Want To Enter Below:
Full Powerlifting (SQ-BP-DL for a total)- Youth ____Teen ____ Junior ____Subs ____ Masters ____ Police/Fire/Military ____ Raw ____ Single Ply ____ Special O ____ Disabled ____ Open____
Bench Only- Youth ____ Teen ____ Junior ____ Subs ____ Masters ____ Police/Fire/Military ____ Raw ____ Single Ply ____ Special O ____ Disabled ____ Open___
Deadlift Only- Youth ____ Teen ____ Junior ____ Subs ____ Masters ____ Police/Fire/Military ____ Raw ____ Single Ply ____ Special O ____ Disabled ____Open___
Squat Only- Youth ____ Teen ____ Junior ____ Subs ____ Masters ____ Police/Fire/Military ____ Raw ____ Single Ply ____ Special O ____ Disabled ____ Open___
ALL FEES ARE NON-REFUNDABLE AND NON-TRANSFERABLE
Date: May 21st, 2011 Start time: 10 am Rules: 9:30-9:45 am sharp
Location: Atlas Fitness, 42 Nichols St., Spencerport, NY 14559
Weigh-ins: Friday 6-7 pm & Saturday 8-9:30 am (please bring equipment for inspection)
Entry Fee: $40 for 1st division or event, $20 for each additional division or event, after initial $100 each additional division is $10.
DEADLINE: All entries must be received by May15, 2011, otherwise a $10 late fee will be assessed. If you don't include it in your initial entry, you must pay it at weigh-ins. If you are going to be a late lifter, please email and have your name put on the roster.
NO REFUNDS OR TRANFERS OF FEES...
Make checks payable to: Patricia Unvericht and mail entry form and payment to: ESPF, c/o Patricia Unvericht, PO Box 303, Spencerport, NY 14559
Weight classes:
Men: 80, 90, 100,114, 123, 132, 148, 165, 181, 198,220, 242, 275 & SHW
Women: 80, 97, 105, 114, 123, 132, 148, 165, 181 & SHW
Divisions:
Youth 9-10 & 11-12, Teen 13-16 & 17-19, Junior 20-23, Subs 35-39, Masters in increments of 10 years, Police/Fire/Military, Special O, and Disabled.
Records:
ESPF New York and United States records can be set.
Awards:
Lifters through third place will be awards as long as they don't bomb out. Best Lifter and Team awards will be awarded too. Places will be determined once the meet is over.
Record Certificates will be given out after the meet.
Please check all the ESPF rules at www.espf.weebly.net
Admission:
No admission for spectators.
We are using pound plates.
Director: Patti Unvericht, [email protected] or 585-329-1723
| espf_entry_form_may.pdf |
Release from Liability Read this carefully. Copy and paste this form, print it out and send it in with your entry form.
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 to include and not limited to Eastern States Powerlifting Federation, Dawane Harris, Patricia Unvericht and Atlas Fitness from any and all liability, including any result of negligence, which may arise from this competition. 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 18 years of age
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 to include and not limited to Eastern States Powerlifting Federation, Dawane Harris, Patricia Unvericht and Atlas Fitness from any and all liability, including any result of negligence, which may arise from this competition. 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 18 years of age
