Entry Form - World Powerlifting Congress

The 2015 APF Big Iron
Iowa & Nebraska State Powerlifting Championships
April 11, 2015
SPONSORED BY:
Jim Grandick’s Big Iron Compound
MEET DIRECTOR:
James Grandick, 402-305-2822
STATE CHAIR:
James Grandick, 402-305-2822, jkgrandick@cox.net
SANCTIONED BY:
The American Powerlifting Federation (APF)
EVENT LOCATION: Omaha South High School
2519 South 24th Street (24th & K Street)
Omaha, NE 68105
HOTEL:
Double Tree Hotel (Mention the APF Powerlifting Meet to receive special rate of $99)
402-397-5141
7270 Cedar Street
Omaha, NE 68124
ELIGIBILITY:
Open to qualified APF registered athletes. All athletes must have a current APF registration card
or purchase one at the meet. Athletes may register at the meet or before weigh-in time with
James Grandick, State Chairman. (APF registration fee $30.00, 18yr and under $15.00)
WEIGH-INS:
Friday, April 10:
9:30am-1pm at Jim Grandick’s Big Iron Compound
5pm-7pm at Omaha South High School
Saturday, April 11:
7:30am-8:30am at Omaha South High School
CHECK IN:
Saturday, April 11:
7am at Omaha South High School
EVENT:
Saturday, April 11:
8:30am Mandatory Rules Briefing
9:30am Lifting will begin!
UNIFORM:
One piece lifting suit or wrestling suit is MANDATORY.
ENTRY FEE:
Entry fee for Full-Power is $75, if received on or prior to the DEADLINE, April 1, 2015. If
received after April 1 an addition $25 late fee is to be added. Bench only will be $50 and push/pull
$65. Certified checks, checks, and money orders are to be made out to: James Grandick
Mail all entry forms and fees to:
James Grandick
252C Follet Road
Council Bluffs, IA 51503
For questions please contact James Grandick 402-305-2822 or Erin Earlywine 402-214-7451.
ENTRY FORM
Name:
Last Name
First Name
MI
Residence:
Street
city
Telephone:
state
zip
E-mail address:
Date of Birth:
APF CARD#
MULTI-PLY EQUIPPED (squat suit, bench shirts, deadlift suits)
Please circle Equipped or RAW indicating how you will be lifting.
RAW (singlet only)
DIVISION ENTERED (circle all that apply): Open
Teen: 13-15, 16-17, 18-19
Junior: 20-23
Submaster: 33-39
Master: 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79,80+
______Men’s Full Meet
$75
______Women’s Full Meet
$75
______Men’s Bench Press/Deadlift
$65
______Men’s Bench Press
$50
______Women’s Bench Press/Deadlift $65
______Women’s Bench Press
$50
Meet T-Shirts: $20 ea.
Weight Class
Weight Class
Weight Class
Weight Class
Weight Class
Weight Class
Age
Age
Age
Age
Age
Age
Size: S___ M___ L___ XL___ 2XL___ 3XL___
We will also be deducting $10 from entry fees that include donated single ply gear for the South High School
Powerlifting team. (This is a one-time discount, regardless of the number of pieces donated.)
TOTAL amount enclosed:
$
**(ENTRY FEES AND CARDS FEES ARE TO BE PAID SEPARATELY, NOT TOGETHER)**
Make Meet Check Payable To: James Grandick
Mail Entry To: James Grandick
252C Follet Road
Council Bluffs, IA 51503
WAIVER AND ATHLETIC RELEASE: On behalf of myself, my heirs, executors, administrators and assigns, I hereby waive,
release and fully discharge any and all officials, sponsors, participants or organizations connected to the Nebraska and Iowa
APF, the APF/AAPF, Jim Grandick’s Big Iron Compound, Bryan Busteed, Omaha South High School and/or any affiliates of,
their respective officials, directors, employees, agents and shareholders, of and from any and all rights, claims, demands,
lawsuits and causes of action due to or arising from any accident, injury, damage or loss directly, indirectly, or in any way
associated with my participation in the 2015 APF/AAPF Nebraska/Iowa Big Iron State Meet, April 11, 2015, including those
caused by the negligent act or omission arising out of or connected with my participation in the Powerlifting competition
or the use of any equipment at the Powerlifting competition. I, also, represent that I know of no medical reason or condition
that would impair my ability to participate in this event, and I hereby assume any and all risk of accidental, medical injury
or consequential damages resulting from my participation. I acknowledge, understand and accept the inherent risk of
powerlifting. In signing this release form, I, the lifter acknowledges and represents the following:
1) Powerlifting is a strenuous athletic event. As a sport, accidents can and do happen periodically as a result of the normal
danger involved.
2) There is a risk of participation. Lifter recognizes this risk and accepts it. Lifter shall have the duty to examine all equipment
prior to use and immediately inform the proper people of any dangerous condition observed in the equipment, personnel
or event venue. The lifter has sole responsibility for the condition of his/her personal lifting gear I.E. bench press shirts,
lifting suits, belts, wraps, and other lifting gear and it is the responsibility of the lifter to wear such gear in a manner that is
safe and least likely to result in injury. The APF/AAPF and its meet directors, officials, and meet employees are not
responsible for lifting gear blowouts, tears, or any defects in lifting gear. Lifter fully understands the risks of the use of
powerlifting gear – especially multi-ply gear in materials such as canvas, denim, and heavy duty polyester and represents
to the APF/AAPF all gear used is in proper condition and being employed as intended.
3) Lifter is in excellent health and capable of performing the feats of strength attempted.
4) Lifter is the sole decider of the amount of weight to be lifted. Lifter will act in a reasonable manner at all times and not
lift weights beyond a safe and prudent level.
5) Lifter has the right to bring his/her own spotters and assistants. If Lifter does not do so, Lifter may use such spotters as
provided by the meet director, solely as a courtesy to Lifter.
6) Neither the APF/AAPF, nor any agent, servant nor employee of the APF/AAPF, nor any other competitor shall be liable
to the Lifter for any harm or damage to Lifter, unless such harm is the result of the intentional or reckless conduct of such
person, which conduct shall not be imputed to any other person or organization. No action for negligent entrustment shall
exist.
7) Lifter will be responsible for his/her behavior and acts and those of his/her guests. If Lifter does not act in accord with
the rules of the APF/AAPF for competition or behavior, he/she may be asked to leave the event immediately by an event
director and will do so voluntarily and shall forfeit all fees paid. In the event litigation should occur, Lifter shall be
responsible for payment of the reasonable attorney’s fees of the successful party.
8) This Release is reasonable, executed freely, without duress or undue influence, and after opportunity for careful and
independent review.
9) I understand there is random drug testing by urinalysis on a minimum of 10% of all AAPF lifters. AAPF/AWPC policy
permanently bans any Lifter testing positive for a banned substance.
I HEREBY REPRESENT AND WARRANT THAT I HAVE READ THE ABOVE RELEASE, UNDERSTAND IT’S MEANING AND
CONSEQUENCE, AND AGREE TO BE LEGALLY BOUND BY IT’S TERMS. I HAVE SIGNED THIS RELEASE FREELY AND
VOLUNTARILY.
________________________________
Signature of Participating Lifter
___________________
Date
______________________________________________
Signature of Parent or Guardian’s (If Lifter is under 18)