DRAGON WEIGHTLIFTING CLUB
PO BOX 160662
SACRAMENTO, CA 95816

Please complete this form and return it with your entry fee of $35.00 to:
I agree by signing this form for the 2006 Pacific Weightlifting Championships (USAW/PWA #38-06-7), 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 Sacramento 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 Q-TOTAL________________________________ A SESSION___________ B SESSION__________ FEMALE__________ MASTER___________ 2006 USAW CARD NUMBER______________USAW CLUB_______________________________ AGE___________ DATE of BIRTH_______________ T-SHIRT SIZE___________________ EMAIL ADDRESS______________________________________________________________ ENTRY MUST BE POSTMARKED BY JULY 31, 2006 TO AVOID LATE FEE Any questions may be directed to: Paul Doherty at (650) 704 - 2482