UPA Utah Strength Sports Coalition 2014 Championships @ PSM BARBELL Saturday, April 26, 2014 Entry Form _____________________________________________________________________________ Last Name First Name Middle Initial Address_________________________________________________________________________________________ City_____________________________________________________ State______________ Zip Code_____________ Home Phone___________________________________ Work Phone _______________________________________ E-Mail ________________________________________________________ Date of Birth_______________________ Wt. Class (Men): 114 123 132 148 165 181 198 220 242 275 308 SHW (circle one) Wt. Class (Women): 97 105 114 123 132 148 165 181 198 Unlimited (circle one) Division/Age Group: Open Junior (20-23) Teen (13-15) Teen (16-17) Teen (18-19) Sub master (33-39) Masters: 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 (circle one) □ Full Meet □ Bench-only Non-UPA lifters may purchase memberships at the meet ($30 for UPA and $10 for USSC) □ Dead lift-only □ RAW Full Meet Entry Fee--$60 BENCH ONLY – DEADLIFT ONLY$ 60 Additional Divisions Entry Fee--$30 UPA card=$30, USSC card=$10 Total □ Cash payment enclosed □ Check payment enclosed □ Money order payment enclosed ALL COMPETITORS MUST R.S.V.P. to: [email protected] ASAP with their name, address, phone number, weight class, division/age group, and whether they’re full meet, bench-only, deadlift-only. Send entries via mail to Jason Gibson (Address below). Make checks or money orders payable to: Jason Gibson. Note: Each athlete MUST show his/her UPA membership card at weigh-in. If he/she cannot, then they will have to buy one and their membership will be extended a year. USSC athletes MUST also have a USSC membership to compete in this meet. Waiver: In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors, and administrators waive and release any and all rights and claims for damages I may have against the UPA, USSC, Jason Gibson, Ed Kinsey, and PSM Barbell, their representatives, successors, and assigns for any and all injuries or bodily harm that I might suffer while competing at the UPA Utah Strength Sports Coalition Championships on February 22-23, 2013. _____________________________________ Mail entries to: CELL # 1-801-920-4165 JASON # 1-801-698-8003 ED Jason Gibson 2957 WEST 4275 SOUTH Roy, UT 84067 Signature of Competitor or Parent/Legal Guardian if Competitor is under 18 years of age MEET DIRECTOR: Jason Gibson 801-920-4165 *E-mail [email protected] Ed Kinsey 801-698-8003 *E-mail [email protected] EVENT LOCATION: PSM Barbell / Mori Academy 5385 S 1950 W Roy, UT 84067 ELIGIBILITY: Open to all UPA and USSC Registered Athletes: Must show proof of UPA card at weigh in. All entries in UPA sanctioned events must have a valid UPA Registration card. Fee is $30 per card. UPA registration for high school $15. Registration will be available at weighins. USSC membership is $10. WEIGH-IN: 24-HOUR WEIGH-IN RULE APPLIES Weigh INS: PSM Barbell / Mori Academy 5385 S 1950 W Roy, UT 84067 Friday April 25: 9-11 am, 5-6 pm Saturday, April 26: 7- 8:30 AM EVENT START TIME: Saturday Aril 26th @ 10 AM Mandatory Rules Meeting: 9:15 AM CONTEST LIFTS: Full Power, Bench Only, Deadlift Only AWARDS: Amateur: 1st-3rd in each weight class in each division. There will be best lifter awards by the Schwartz Formula. RULES: United Powerlifting Association (UPA). Check www.UPAPower.com for information and rulebook. UNIFORM: Must have one piece lifting suit or wrestling suit (Singlet).
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