2009 WERKSAN SPRINGFEST ENTRY

2009 WERKSAN SPRINGFEST
MAY 23, 2009
ENTRY FORM

Please complete this form and return it with your $20.00 Entry Fee by May 19th, 2009
(Make checks payable to Dave Swanson)

Dave Swanson
PO Box 693
Lincoln, CA 95648

I agree by signing this form for the 2009 WerkSan Springfest (USAW/PWA #38-09-05), that I will abide by all of the rules of USA Weightlifting (USAW) and the 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 DATE OF BIRTH _________________________ 2009 USAW CARD NUMBER_________________ EXPIRATION DATE ____________________ HIGH SCHOOL___________________________________________________________________ EMAIL ADDRESS_________________________________________________________________ ENTRY MUST BE POSTMARKED BY MAY 19, 2009 Any questions may be directed to Dave Swanson (916) 768-9616 A VIP Fundraiser Reception will immediately follow the weightlifting. For more information contact Dave Swanson or Paul Doherty.


Please complete this form and return it with your $20.00 Entry Fee by May 19th, 2009 (Make checks payable to Dave Swanson)

	Dave Swanson PO Box 693 Lincoln, CA 95648



I agree by signing this form for the 2009 WerkSan Springfest (USAW/PWA #38-09-05), that I will abide by all of the rules of USA Weightlifting (USAW) and the 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 DATE OF BIRTH _________________________ 2009 USAW CARD NUMBER_________________ EXPIRATION DATE ____________________ HIGH SCHOOL___________________________________________________________________ EMAIL ADDRESS_________________________________________________________________ ENTRY MUST BE POSTMARKED BY MAY 19, 2009 Any questions may be directed to Dave Swanson (916) 768-9616 A VIP Fundraiser Reception will immediately follow the weightlifting. For more information contact Dave Swanson or Paul Doherty.