ENTRY FORM

(PLEASE PRINT)

NAME: ______________________________________AGE: ______________SEX:_____________

ADDRESS: _______________________________________________________________________

                                        Street Address                             City                                         State                       Zip

PHONE: (_____)____________________________     E-MAIL:___________________________

TEAM: __________________________

WEIGHT CLASS: ________________ USAPL #: _____________________

DIVISIONS ENTERED:

(Circle one or more)

                     BENCH          OPEN       WOMEN      MASTERS     TEEN        JUNIOR     ($25 each additional division)

                    DEAD LIFT    OPEN       WOMEN      MASTERS     TEEN        JUNIOR

SHIRT ($13.00 each): _______ SIZE(S): ________

VIDEO ($25.00): __________TICKETS:  ($7.00) __________

IF PREVIOUSLY TESTED: WHERE: _____________WHEN: _____________TYPE OF TEST: _____________

In consideration of my entry, I , intending to be legally bound, hereby, for myself, my executors and administrators, waive

and release the USAPL,  B & W Gym,Highland Park Hospital,Health and Fitness Center, Evanston Northwestern Hospitals Highland Park Hospital, Power Wellness LLC, their agents, representatives, committees and members from any and all claims or rights to damage from injuries or losses suffered by me directly or indirectly competing in or attending the 2002 USAPL ALL MIDWEST BENCH-PRESS AND DEAD LIFT  CHAMPIONSHIPS.

I agree to abide by the USAPL rules governing this event.

Signature: ____________________________________________________Date: ___________

If minor, Parent’s Signature: ______________________________________________Date: ___________

In consideration in the acceptance of my entry blank in this power lifting competition, I intend to be legally bound, for not only myself but also for my heirs, my executors and my administrators. In signing this release from liability I waive and release everyone connected with this competition from any and all liability which may arise from this competition.

Moreover, I agree that any testing method which the meet director and the sponsors of this meet use to detect the presence of strength-inducing drugs SHALL BE CONCLUSIVE. That is, whether I think the results of the tests are right or wrong, I agree that I have no right to challenge the results of the drug tests. I further agree to submit to any physical tests which may be necessary to complete the drug testing. Should I fail to pass the drug test, I agree to waive any claim which might arise under state law for defamation, slander, libel, or any other claim for which legal relief is available.

I agree to pay an attorney fee and litigation expenses incurred by any person, real or corporate, whom I may sue in an effort to challenge this release from liability form. I understand that my agreement to pay attorney fees and litigation expenses is the sine qua non for the acceptance of my entry in this contest.

______________________________________________                                        _____________________________________________________

I hereby give my word of honor as an athlete that I have not used any strength-inducing drugs (i.e., any anabolic steroid

or natural hormone) as part of my training during the past 36 months or any prohibited stimulants or diuretics in the seven days prior to the contest.

_______________________________________

Signature in full of applicant