DungeonofPrideClothing.com. Bench Only & Full Power (All Men s Open lifters):

Similar documents
2018 UPA Illinois State & Midwest Powerlifting Championships September 22, 2018

Diana Golden Race Maine Adaptive Sports & Recreation Sunday River, ME January 15, Race Schedule

2018 IBS 600 YARD NATIONAL CHAMPIONSHIPS BENCHREST RIFLE CLUB OF ST. LOUIS WRIGHT CITY, MISSOURI OCTOBER 6 & 7, 2018

OFFICIAL ENTRY FORM ENTRY FEE: $250 / DEADLINE FRIDAY, SEPTEMBER 7 / 5PM PST. Estimated Competition Weight: Height: Age:

2017 U14 Eastern Championships All information subject to change

LAST CHANCE. PUSH/PULL Bench Press A.A.U. Meet!

PARENTAL CONFIRMATION AGREEMENT

RELEASE AND WAIVER OF LIABILITY Sports Authority Football Field Day

2018 Jr. Celtics Two-day Winter Break Clinic Registration Form

PARTICIPANT APPLICATION & RELEASE WEIGHT LOSS SHOW

2018 BALTIMORE RAVENS CHEERLEADER APPLICATION

Registration Form. Our Lady of Guadalupe High School Retreat. February 23 25, 2018 Camp Zephyr, Sandia, TX Cost: $140.00

FITNESS CENTER LICENSE AGREEMENT

2015 BALTIMORE RAVENS PLAYMAKERS APPLICATION

Registration Form Please Check: Boy Girl Age: Camper s Name: Address: City: State: Zip Code:

~LOTUS GUNWORKS OF SOUTH FLORIDA, LLC~ RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS, AND ASSUMPTION OF THE RISK AGREEMENT

ASSUMPTION OF RISK, RELEASE AND LIABILITY WAIVER

Camp Pump It Up Registration Form

2017 Multi-Jurisdictional Law Enforcement Explorer Academy

2017 BALTIMORE RAVENS CHEERLEADER APPLICATION

Registration Form Please Check: Boy Girl Age: Camper s Name: Address: City: State: Zip Code:

early registration ends September 4

69 th Annual Michigan-Wisconsin Tennis Open

DO NOT SIGN UNTIL YOU HAVE COMPLETELY READ THIS RELEASE IN ITS ENTIRETY AMERICAN IDOL SEASON 11 PERSONAL RELEASE In full and complete consideration

IF WE ARE INTERESTED OR HAVE MORE QUESTIONS ABOUT YOUR FAMILY AND/OR SITUATION, WE WILL CALL YOU. IT COULD BE SEVERAL MONTHS BEFORE YOU HEAR FROM US!

Registration Form. Camper Information. Camper s Name: Camper s Gender: Camper s Age (as of June 1, 2018): Parent s/guardian s Name(s)

POLE VAULT ELITE WAIVER

WINTER CARNIVAL 2018, March 3 CARDBOARD CLASSIC Theme: SUPERHEROES

PURCHASES REFUNDS. LOST BADGE or ITEMS WAIVER / ASSUMPTION OF RISK / RELEASE OF LIABILITY. Terms of Service

Cranston Parks & Recreation Playground Program

LATIN TALENT SEARCH WAIVER OF LIABILITY, PERSONAL RELEASE AND CONSENT FORM

Contact: Mailing Address: 4275 W. Rosted Rd. Lake City, MI.

TEAM ONALYSIS Hosts A USATF Sanctioned Cross Country Meet at Golden Gate Park, Polo Fields in San Francisco Sunday, October 28, 2018

BRIDIE McCANN MEMORIAL RACE 1K OPEN WATER SWIM Sunday, August 10, 2014

GENERAL APPEARANCE RELEASE FORM

MINOR HOCKEY CROSS ICE JAMBOREE - NOVICE

Student Name: Student Phone: Birthday: \ \ Physical Address: Mailing Address: Primary Parent/Guardian:

OWNER'S NAME HORSES NAME MAILING ADDRESS PROVINCE POSTAL CODE PHONE NUMBER ARE YOU AN NSEF PROV CHAMP ENTRY CIRCLE YES OR NO

Iron Gate Exhibition

Instructions for Completing Waivers

Southeast Schooling Show Championships Chattahoochee Hills October 7 th and 8 th

LET S MAKE A DEAL CONTESTANT SEARCH 2017 ELIGIBILITY REQUIREMENTS

THE PRICE IS RIGHT CONTESTANT SEARCH JACKSON RANCHERIA CASINO RESORT SEPTEMBER 25, 2015 PARTICIPANT APPLICATION

2009 Junior Idol Karaoke Contest Preliminary Round Saturday August 1st, a-12p at Ranch and Home in Kennewick

WAIVER AND RELEASE, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT PLEASE READ THE FOLLOWING CAREFULLY AS IT AFFECTS YOUR FUTURE LEGAL RIGHTS.

PARTICIPANT S REPRESENTATIONS, EXPRESS ASSUMPTION OF ALL RISKS & RELEASE OF LIABILITY AGREEMENT FOR OAK RIDGE HIGH SCHOOL PERFORMANCE TRAINING CENTER

WELCOME TO THE Y! TORRANCE SOUTH BAY YMCA ADULT #1 EMERGENCY CONTACT. How did you hear about the. Were you referred by a current member?

TO BE SIGNED BY PERSON(S) WHO APPEAR AND/OR WHOSE VOICE CAN BE HEARD IN VIDEO

Founder's Week Flyaway Contest

Name: Age: Gender: Address: City State Zip Tribe(s) if applicable: Children s Name(s) attending camp: Phone Number(s): H W C.

Exhibitor Guidelines and Agreement

Youth Police Academy C/O: Clare Police Department 207 W. Fifth Street Clare, MI (989) Membership Application 2017

AMERICA S FUNNIEST HOME VIDEOS PERSONAL RELEASE AND GRANT OF RIGHTS (Version 11/20/09)

PARTICIPATION AGREEMENT

!!!! "#$"!%&'()*&+!,-+-.'()*!/-0&''&!1!2*'34!5&.6-'!

GET SUMMER TEEN CODE OF CONDUCT

USA National Karate- do Federation Code of Conduct and Athlete Agreement

I-SEE-YOU CONTENT SUBMISSION EXCLUSIVE RELEASE AND GRANT OF RIGHTS

Membership Application

CONTACT INFORMATION SECTION 1: SPONSORSHIP OPPORTUNITIES. Company Name: Primary Contact Person: Price Quantity Total

Oklahoma City University Travel Waiver and Release Agreement

SUMMER WINTER ACTION TOURS, LLC DBA SWAT SPRING BREAK 2015 SURVEY GIVEAWAY CONTEST (the Contest ) I do hereby declare that I, of,

GRACIE GARAGE PARTICIPANT ASSUMPTION OF RISK, CONSENT TO PARTICIPATION, WAIVER OF LIABILITY AND RELEASE OF CLAIMS, AND INDEMNIFICATION AGREEMENT

Swimming Classes. REGISTRATION DEADLINE: June 15, 2018

Last Bride Standing Contestant Application A division of Long Valley Productions, Inc.

Calgary Police Cadet Corps Application

HEALTH INFORMATION AND CONSENT FOR EMERGENCY MEDICAL TREATMENT FORM. Program Attending: Date of Program: Name of Student or Minor Child: Birth Date:

ASSUMPTION OF RISK / WAIVER OF LIABILITY / PUBLICITY RELEASE (the Agreement )

SPONSORSHIP APPLICATION Pointe Hilton Squaw Peak Resort - Phoenix, Arizona February 17 19, 2017

Terms and Conditions of Attendance and Participation Consensus 2016

2016 Ulua Challenge TOTAL:

1 P a g e. Registration. Registered Name of Horse. Pet Name & Age of Horse. Coat Color/Mare or Gelding. Sire and Dam. Name of Horse Owner

C ITY OF C H A R L O T T E S V I L L E

REGISTRATION CHECKLIST

C-WAGS Sponsored. Scent Trials. Held at: For Your K Cornell Dr. Melrose Park, IL Saturday March 18, 2017

SACRED. Transformations. Application for Tattoo Transformation Program

NO PURCHASE NECESSARY TO ENTER OR WIN. A PURCHASE WILL NOT INCREASE YOUR CHANCE OF WINNING.

3:00 to 7:00 PM Fine Arts ALL MAILED ENTRY FORMS MUST BE POSTMARKED ON OR BEFORE THE ENTRY DEADLINE. LATE ENTRY FORMS WILL NOT BE ACCEPTED.

The Windsor International Film Festival Corporation s 48-Hour FlickFest package contains the following:

YOUR INVITED TO TRYOUT FOR TEAM IGLOO LACROSSE

b. Only one winner per household is permitted.individuals may only win a Stationconducted contest/sweepstakes once every sixty (60) days.

Avantiplus Cairns Pty Ltd as trustee for Avantiplus Cairns Trust PARTICIPANT'S ACKNOWLEDGEMENT OF RISK FORM INCLUDING WAIVER, RELEASE & INDEMNITY

REGISTRATION CHECK LIST & POLICIES

EXEMPTION AND RELEASE FROM LIABILITY

The AMA and Minors. To summarize- to sign a minor up you will need either-

Contestant Application

Sponsorship Application

Annual Cotillion Program

SPACE IS LIMITED.REGISTER NOW!

HARD ROCK S AMBASSADORS OF ROCK BATTLE OF THE BANDS ENTRY FORM

STATIC DISPLAY AIRCRAFT PAPERWORK PACKAGE

Initials PLEASE READ CAREFULLY EACH PARAGRAPH BEFORE SIGNING. A. General

Photo & Go Mother s Day Meet Pitbull 2017 Photo Contest Official Rules

KFC Canada Legendary Deliveries Official Contest Rules

Minor Waiver (Paper and Electronic) HFAC Water Activities Version 5/14

Showing Up is a Slam Dunk Video Contest Rules and Guidelines

Rider #1 Name Civic P.O. Province Postal Code Phone

Pastors Conference 2018 Exhibit Hall Drawing. OFFICIAL CONTEST RULES (Prizes Under $600 and Not for Services)

Kiss Your Landlord Goodbye! Contest Official Rules

Tallcedarsfarm.org Rocky Ridge Road Glen Allen VA 23059

Transcription:

2017 UPA Powerlifting & Bench Press National Championship April 22 nd & 23 rd, 2017 XPC Arnold Classic Qualifier & GPC Worlds Qualifier Updated on 8/7/2016 MEET DIRECTOR: Bill Carpenter - President - 563-599-1390 *E-mail BCarpenter@UPAPower.com EVENT LOCATION: ELIGIBILITY: WEIGH-IN: Grand River Center (www.grandrivercenter.com) *Right next to the Grand Harbor Resort & Water Park 500 Bell Street - Dubuque, Iowa 52001 Exhibit Hall B Open to all UPA registered athletes with qualifying total: 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. Registration will be available at weigh-ins 24-HOUR WEIGH-IN RULE APPLIES Weigh INS. NO SAME DAY WEIGH INS * The Grand River Center 500 Bell St. Dubuque, IA 52001 All Equipped & Raw Men s Open Full Power & Bench Only: Friday April 21 sr, 9 AM 12 PM & 5 PM 7 PM All Equipped & Raw Full Power, Woman, Teen, Jr. & Masters: Saturday April 22 nd, 9 AM 12 PM & 5 PM 7 PM Title Sponsor: EVENT START TIME: DungeonofPrideClothing.com Saturday April 22 nd, 9 AM Bench Only & Full Power (All Men s Open lifters): Sunday April 23 rd, 9 AM Full Power (All Women, Teen, Junior, & Masters): Mandatory Rules Meeting: Saturday April 22 nd and Sunday April 23 rd, 8:15 AM CONTEST LIFTS: Full Power & Bench Only

SESSIONS: Saturday Bench Only & Full Power (All Men s Open lifters): Sunday Full Power, Woman, Teen, Jr. & Masters Qualifying Totals for Equipped and Raw Men s Open: *Meet Promoter can waive qualifying totals to let a lifter compete. Class 114 123 132 148 165 181 198 220 242 275 308 SHW Equip - 753 973 1161 1207 1532 1641 1726 1818 1881 1940 1978 2022 Raw - 551 623 738 969 1156 1283 1371 1476 1525 1608 1653 1696 AD-Eq - 557 753 959 1079 1200 1353 1453 1535 1590 1648 1671 1690 AD-Raw- 501 573 638 869 1006 1133 1221 1326 1375 1458 1503 1546 **Total has to be done at a UPA sanctioned meet within the last 12 months** **There will be no qualifying totals for Women s Open ** ** There will be no qualifying bench for the Bench Press** AWARDS: ENTRY FEE: MEET HOTEL: ONLINE ENTRY: RULES: UNIFORM: SPECTATOR FEE: Photos & Cameras: 1st-3rd in all division by weight class & total. There will be best lifter awards by the Schwartz Formula: $100 Full Power 1st division, $85 Bench Only,$40.00 Additional Division UPA & UPA- AD. UPA-AD Division (drug tested): Add $10 to above for 1st division,.**no same day entries will be accepted unless approved by Bill Carpenter prior to arrival** A $30 late fee will be charged for entries received after March 31 st, 2017. No refunds on entry fees.**no EXCEPTIONS** We will only be accepting 55 Full Power Entries for each day Saturday & Sunday. This meet fills up fast. It is highly recommended to get your entry forms in on time if you want to do this meet. Late entries are always taking a chance of not getting on the roster for the meet. Grand Harbor Resort & Water Park. The meet site (Grand River Center) is connected by sky walk to Grand Harbor Resort & Water Park. Mention UPA to get $109 a night room rate. www.grandharborresort.com 563-690-3270. The cut-off date for accepting reservations into this room block is Wednesday, March 22 nd, 2017. Will be available online at www.upapower.com United Powerlifting Association (UPA). Check www.upapower.com for information and rulebook. Must have one piece lifting suit or wrestling suit $10 at the door Sat. Full Power & Bench Only /$10 at the door Sun. Full Power, Or $15 for all 2 days: **Children 10 and under - free/ lifters are only free for their day to lift. Coaches and handlers are not free.** Photo cameras, hand held video cameras, or tripod stands ARE NOT ALLOWED at any UPA Events. *Cell Phone Photos & Videos are allowed.

17 UPA Powerlifting & Bench Press National Championship Mail entry to: Bill Carpenter - UPA 145 State St. Dubuque, IA. 52003 First Name: Last Name: Address: City: State: Zip Code: E-Mail: Home Phone: Work Phone: Occupation: Age at time of competition: Date of Birth: Team Name: Meet name & Qualifying total: Division Entered: Full Power Bench Only Raw (Unequipped) Equipped Men s Open Women s Open Mens Master s (please circle your age group below) 33-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Womens Master s (please circle your age group below) 33-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Junior (20-23) Teenage (please circle your age group below) 13-15 16-17 18-19 **If you are entering the UPA-AD (drug tested) please check here Weight Class: Men 114 123 132 148 165 181 198 220 242 275 308 SHW Weight Class: Women 97 105 114 123 132 148 165 181 198 SHW Weight Class: UPA #: Exp. Date:

Full Power Entry Fee $100.00: Bench Only $85: Team Entry $50 (10 lifter teams: Please list lifters) *$50 COACHES FEE NOT A LIFTERS FEE! Add $40.00 for Additional Div. UPA & UPA-AD Add $10.00 for UPA-AD: Add $30.00 for UPA Card: Add $30 for entry after March 31 st : Add $20 for each t-shirt ordered: *I will not accept any PERSONAL CHECKS after the entry deadline! You can pay with PayPal, Money Order or Credit Card after entry deadline (3/31/2017) NO REFUNDS ON ENTRY FEES **NO EXCEPTIONS** Circle Sizes-S, M, L, XL, XXL, XXXL Number of Shirts TOTAL DUE: (Make checks payable to Bill Carpenter -UPA) Paid: Cash $ Check # Credit Card (4% Surcharge) Name On Card (PRINT CLEARLY): Credit Card Number: Card Type (Circle One): Visa MasterCard Amex Discover CVV2 Number (on back of card): Expire Date (Month/Year): Release and Waiver In consideration of being allowed to participate in any way in the Name of Event UPA Powelifting & Bench Press National Championship( Event ) promoted by Name of Promoter Bill Carpenter. ( Promoter )and sanctioned by the United Powerlifting Association, LLC, its related events and activities, I, please print name ( ), the undersigned, acknowledge, appreciate and agree that: 1. The risk of injury from the activities involved in this Event is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE PROMOTER AND/OR THE UPA, LLC or others, and assume full responsibility for my participation; and 2. I willingly agree to comply with the stated and customary terms and

conditions for participation, if, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Promoter immediately; and 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE PROMOTER AND THE UPA, LLC and each of their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used for the activity ( Releasees ), WITH RESPECT TO ANY AND ALL INJURY DISABILITY, DEATH, or loss or damage to person or property associated with my presence at or participation in or in traveling to and from the Event, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I understand there is a random drug testing by urinalysis on a minimum of 10 % of all UPA-AD division lifters. The UPA will permanently ban any lifter testing positive for a banned substance from the UPA-AD division. I hereby grant the UPA, LLC Promoter and/or any other UPA, LLC -approved video or entertainment organization and all of their agents, successors, licensees and assigns, the right to photograph or otherwise reproduce (whether by film, tape, still photography or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit, and/or otherwise exploit and all media, including without limitation, by means of still photography, motion pictures, radio, television, television motion pictures, video, printing on digital or any other medium now known or hereafter devised, including with respect also to any merchandising, advertising and/or publicity, and the right to use my name and information about me in any connection with any of the foregoing. The rights granted by me hereunder are granted for the entire universe and shall endure in perpetuity and no further compensation shall be payable to me at any time in connection therewith. Nothing contained herein shall be deemed to obligate the UPA, LLC Promoter, and/or any other UPA, LLC -approved video or entertainment organization, to photograph or otherwise reproduce my voice, appearance or name, or to make use of any rights granted herein. I also understand that the aforementioned rights may be reassigned at any time without further consent. I understand that the UPA, LLC, the Promoter and/or any UPA, LLC-approved video or entertainment organization, are videotaping and photographing the Event in express reliance upon the foregoing, and I represent and agree that I am free to grant the rights granted to the UPA, LLC Promoter and/or any other UPA, LLC - approved video or entertainment organization hereunder. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVE UP SUBSTAINTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Signature Date Signature of parent if under 18 years old: Date (Required): For updates on the Meet go to www.upapower.com GPC Website - http://www.worldgpc.com XPC Website http://www.xpcpowerlifting.com