The 2003 USAPL Pennsylvania State BP Championships
April 5th, 2003
At
Greater Scranton YMCA
706 N. Blakely Street
Dunmore, PA 18512

Sponsored by:


Application Page

Age:________  Date of Birth_____/_____/_____
Wt. Class________  Sex_________ 
Name:_____________________________________________

Address: Street_____________________________________
City________________________________________
State_____ ZIP__________ 

Phone (______)______________________
USAPL Card # _________________
EMAIL_________________________
 

Check All Divisions entered: 

	Male	Female			Male	Female
Open	___	___		Master 1 (40-44)	___	___
High School	___	___		Master 2 (45-49)	___	___
Teen (14-15)	___	___		Master 3 (50-54)	___	___
Teen (16-17)	___	___		Master 4 (55-59)	___	___
Teen (18-19)	___	___		Master 5 (60-64)	___	___
Collegiate	___	___		Out of State	___	___
Junior(20-23)	___	___		Special Olympian (14 & up)	___	___

*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

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

Amount Enclosed: $___________

Contest Sponsors: