Please complete this form and return it with your entry fee of $35.00 to:
	KEVIN DOHERTY 600 FREMONT AVE. LOS ALTOS, CA 94024
I agree by signing this form for the 2006 NorCal Open (USAW/PWA #38-06-4), that I will abide by all of the rules of USA Weightlifting (USAW) and the Pacific Weightlifting Association (PWA). I will not hold responsible USAW, the PWA, the Officials and Organizers of this event or Abraham Lincoln High School for any injuries that may happen to me while competing in, or while traveling to and from, this event.
SIGNATURE_____________________________________________ DATE________________ SIGNATURE OF PARENT (IF UNDER 18 YEARS OLD)________________________________ PLEASE PRINT THE FOLLOWING VERY CLEARLY: NAME___________________________________________ PHONE #(____)______________ ADDRESS_____________________________________CITY________________ZIP________ BODYWEIGHT CLASS________________KG QUALIFTING TOTAL ____________________KG SESSION A_________ B________ FEMALE________ MASTER_______ SCHOOLAGE________ 2006 USAW CARD NUMBER______________USAW CLUB_______________________________ AGE___________ DATE of BIRTH_______________ T-SHIRT SIZE___________________ EMAIL ADDRESS______________________________________________________________ ENTRY MUST BE POSTMARKED BY MAY 16, 2006 TO AVOID $50.00 LATE FEE Any questions may be directed to: Kevin Doherty at (415) 290-4907