|Please complete this form and return it with your $50.00 Entry Fee|
by Thursday, May 23rd, 2013 (NO LATE or SAME DAY ENTRIES ACCEPTED!) to:
9660 Elk Grove-Florin Rd, Suite D
Elk Grove, CA 95624
(Make checks payable to WarriorZ)
|I agree by signing this form for the 2013 WarriorZ Open (USAW/PWA # 38-13-08), 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 WarriorZ Health & Fitness or WarriorZ Barbell Club for any injuries that may happen to me while competing in, 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 Northern California Open 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 WarriorZ Health & Fitness or WarriorZ Barbell Club and the PWA.
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 _______________ MALE/FEMALE ________ CURRENT USAW CARD#_____________ EXPIRATION DATE ______________ T-TOP SIZE________ USAW CLUB________________________________________________________________________ EMAIL ADDRESS____________________________________________________________________ Any questions may be directed to Kathy Redcher-Bowling - (916) 541 - 3022