ENTRY FORM

(PLEASE PRINT)

NAME: ______________________________________AGE: ______________

ADDRESS: _______________________________________________________________________

                                        Street Address                             City                                         State                       Zip

PHONE: (_____)____________________________     E-MAIL:___________________________

TEAM: ________________________________

WEIGHT CLASS: ________________ USAPL #: _____________________

DIVISION:      OPEN        WOMEN         TEEN        JUNIOR        MASTER   

($60 checks made payable to B&W GYM - $35 each additional division)

Team Entry: $50

Entries must be received by April 21, 2003

T-SHIRT ($12.00 each): _______ SIZE(S): ________

VIDEO ($25.00): __________TICKETS: ($9.00) _________

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, St. Benedict High School and B & W Gym, 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 2003 USAPL 21st ANNUAL VIKING OPEN  POWERLIFTING 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 powerlifting 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