2009 DON WILSON/GOLDEN WEST OPEN

Sanctioned by USA Weightlifting & PWA #38-09-09

2009 DON WILSON/GOLDEN WEST OPEN

ENTRY FORM

NOVEMBER 15, 2009

PLEASE COMPLETE THIS FORM AND RETURN IT WITH YOUR ENTRY FEE OF $30.00 (CHECKS MADE OUT TO HARRY THEODORIDES) BY TUESDAY NOVEMBER 10, 2009 TO:

HARRY THEODORIDES; Sacramento State University, 6000 J St., Sacramento, CA 95819-6073. NO REFUNDS

I agree by signing this form for the 2009 DON WILSON/GOLDEN WEST OPEN

(USAW/PWA sanction #38-09-09) that I will abide by all the rules of USA Weightlifting and the Pacific Weightlifting Association. I will not hold responsible the USAW, PWA, the Officials and Organizers of this event, Sacramento State University or the S&C Graduate WLC of any injuries that may happen to me while competing or while traveling to and from this event.

I (and my parent or guardian if I am a minor) agree to be filmed and photographed at the venue, to include the use of my name, biographical information, interviews, photographs, portrait and motion pictures and television recordings of my weightlifting performance and grant to the Organizers the right to record and make use of the same, and to authorize others to do so in promoting the competition and the success of the weightlifting team on which I compete, to promote the sport of Weightlifting, and to fund the activities of the Sacramento State University or the S&C Graduate WLC and the PWA.

SIGNATURE_______________________________DATE_______________________

SIGNATURE OF PARENT IF UNDER 18 YEARS OLD_______________________

PLEASE PRINT THE FOLLOWING VERY CLEARLY!!!

NAME________________________________PHONE #( )___________________

ADDRESS____________________________CITY___________________ZIP______

USAW CARD NUMBER____________ EXPIRATION DATE________________

BODYWEIGHT CLASS________MALE______FEMALE______MASTER______

JUNIOR/NOVICE______USAW CLUB_____________________________________

AGE______DATE OF BIRTH____________T-SHIRT SIZE: XXL, XL, L, M, S

ENTRY AND FEE MUST BE IN THE POSSESSION OF HARRY THEODORIDES OR POSTMARKED NO LATER THAN TUESDAY, NOVEMBER 10, 2009 TO AVOID LATE FEE!!!

NOTICE: The late fee has been raised to $50.00 because so many people have registered in past meets the day of the competition which creates a great deal of extra work for the meet director and others involved in hosting the meet. Also, many entries get filled out incorrectly which becomes a big problem not only for the local director but also for the home office in Colorado Springs. Early entries give us the opportunity to make corrections and adjustments. SO, GET YOUR ENTRIES IN ON TIME AND CORRECTLY COMPLETED!!

ALSO NOTICE: You must compete in a ONE PIECE LIFTING SUIT or tight fitting Shorts and T-shirt that covers the trunk and does not cover knees or elbows as stipulated by the rules.