Necedah State Form 2015 (3)

The 2015 Wisconsin High School State Powerlifting Meet March 14th – 15th 2015 Hosted By: NAPLA Necedah Powerlifting This is a USAPL sanctioned event Entries Must Be Postmarked By – Wednesday, March 4th, 2015 NO LATE ENTRIES ACCEPTED ***ALL ATHLETES MUST/PROVIDE PROOF OF HAVING A VALID USAPL MEMBERSHIP TO PARTICIPATE IN THE MEET*** Visit the USAPL Website to secure your USAPL CARD/MEMBERSHIP http://www.usapowerlifting.com/membership-­application/ LOCATION OF MEET:
Necedah High School High School
1801 S. Main, Necedah, WI 54646
MEET DIRECTOR'S PHONE and E-MAIL
Erich Mach Cell-(608) 547-8681 Work-(608)547-8681
emach@necedahschools.org
MEET FORMAT:
• A $40.00 dollar Entry Fee for State Meet THIS DOES NOT INCLUDE USAPL CARD
• Running one Division for lifters 9th – 12th Grade.
• 3 Sessions (Session I Saturday a.m.)
(Session II Saturday p.m.)
(Session III Sunday a.m.)
• Individual Awards will be given after each session with Team Awards presented after
session II for girls and boys after session III.
• This will be run as a four platform meet
• 10 minute break after each event on the individual platforms. Platforms will run
independent from one another.
• Flights of lifters may be shifted for deadlifts ONLY if one platform is ahead of schedule.
• Announcer and (Marksteiner Program) will be used. Overheads will be available for
Back-Up
• Meet Results will be run with Microsoft Excel Spreadsheet
LIFTING INFORMATION
This is a preliminary
schedule, weight classes are subject to change as in the past.
Lifting Schedule
Sessions
Weight Class
Registration
Equipment
Check
Weigh-Ins
Session I
Saturday
March 14th
Session I
Girls’ Division 97-148
7:00-8:30 am
(Entrance back
Gym)
7:00-8:30 a.m.
(Entrance back
Gym)
7:00-8:30 a.m.
(Locker
Rooms)
Saturday
March 14th
WHSPA Meeting
Session II
Saturday
March 14th
Session II
Girls’ Division 165198+
Boys’ Division 114-132
Session III
Sunday
March 15th
Session III
Boys’ Division 148275+
Rules
Meeting
Lifting Start
Time
8:00 a.m.
9:00 a.m.
2 p.m.
2:30 p.m.
8:00 a.m.
9:00 a.m.
(7:30 a.m. in Library)
12:30-2:00 p.m.
12:30-2:00 p.m.
12:30-2:00 p.m.
(Locker Room)
7:00-8:30 am
(Entrance back
Gym)
7:00-8:30 a.m.
(Entrance back
Gym)
7:00-8:30 a.m.
(Locker
Rooms)
MEET AWARDS:
• Lifter Medals 1st – 5th
• Lifter Trophies 1st – 3rd
• Best Lifter Trophies 1st – 3rd for Boys & Girls
• Team Trophies 1st – 3rd Place for Boy’s Team & Girl’s Teams in Divisions 1, 2, & 3
Early Equipment Check: Friday, March 13th 5 to 6:30 P.M. This is a USAPL sanctioned event Entries Must Be Postmarked By – Wednesday, March 4th, 2015 Entry Fee $40.00 per lifter
THIS DOES NOT INCLUDE USAPL CARD
USAPL CARDS MUST BE PURCHASED PRIOR TO THE EVENT. WITH
PROOF OF MEMBERSHIP REQUIRED TO LIFT AT THIS EVENT
(Please Make Checks Payable to NAPLA Powerlifting)
State Meet T-Shirts will be available at the Meet
Programs $3.00
Daily Admissions will be $10.00 Adults $7 Students 5 and under Free
Event (2) Day Admission will be $18.00 Adults $12 Students
Team Entries are automatically calculated at the Scoring Table. However, TEAM FORMS WILL BE USED
AS A BACK UP AND ARE EXPECTED TO BE DONE. Lifters must attend the school of the Powerlifting
Team that they represent. In order for a Powerlifting Team to receive a trophy, they must have at least one
coach who is a paid WHSPA Member. Coaches can pay the $20.00 WHSPA Membership at the Coaches
Meeting on Saturday March 14th at 7:30 A.M.
All Lifters must be in good academic standing at their school and may not have any athletic or extracurricular
code violations in order to compete in the WHSPA State Powerlifting Meet. A school administrator must sign
an “Athlete Good Standing Form” verifying that all participants from their school have met the “Good
Standing” criteria.
As a coach, athlete or team, when you arrive at the venue, you must enter in the
back of the school and enter ENTRANCE A ONLY. You can stop at the registration table to
pick up your team folder, check in lifters, submit USAPL membership forms, and submit Athlete Good Standing
Forms. Once lifters are registered then proceed to the rear of the Main Gym for equipment check-in.
NO COOLERS are allowed into the GYM.
Teams will get one coach’s wristband for every five lifters. Extra wristbands can be purchased for
$5.00/Wristband for any assistants.
2015 WHSPA STATE POWERLIFTING
ENTRY FORM
Name:________________________________
Address:_________________________________________
City:________________________ State:__________ Zip:______________ Phone#:__________________
Age:_________
D.O.B._____________
Male: _____
Female:_____
Grade: Freshman
Sophomore
Junior
Senior
Weight Class: 114 123 132 148 165 181 198 220 242 275 275+
Weight Class: 97 105 114 123 132 148 165 181 198 198+
What Meet Did You Qualify At: _______________________
What Weight Class Did You Qualify At: ____________
Best Qualifying Total of The Season:________
Date of The Meet:______________________
What Was The Total Pounds Lifted: ________
USAPL Card #:____________________
What Weight Class Do You Plan To Lift At State:________________
What School Do You Attend:___________________
Head Coach’s Name:_________________________
In consideration of your accepting this entry, I hereby for myself and my heirs, release any & all rights for
damages for injuries I may have against Necedah High School, USA Powerlifting, NAPLA, Erich Mach and any/all other meet
associates, staff, spotters, loaders, all sponsors, referees as a result of my traveling to, and/or participating in the above
listed competition. I make this release and waiver of claim with full knowledge of the hazards and inherent rights associated
with the above listed competition. I hereby assume the risk of injury and
property damage/loss.
Also, in consideration of accepting this entry I hereby sign over my rights to be videotaped and/or photographed, to the meet
directors and/or his designee. I am fully aware that I will receive no royalties and/or compensation for resale of the videotapes
and/or photos.
RELEASE FROM LIABILITY AND CONSENT TO DRUG TEST. IMPORTANT: READ THIS RELEASE CAREFULLY, BY SIGNING THIS FORM YOU WILL BE GIVING UP IMPORTANT LEGAL RIGHTS. In consideration of the acceptance of my entry in this Powerlifting competition I intend to be legally bound for not only
myself, but also my heirs, my executors, and my administrators. In signing this release from liability I waive and release
everyone connected with the competition from any and all liability, including any results of negligence 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 results of the test are right
or wrong I agree that I have no right to challenge the results of the drug test. I further agree to submit to any physical test,
which may be necessary to complete drug testing. Should I fail to pass drug test, I agree to forfeit any trophies or awards. I
otherwise have won. I understand and agree that if I fail to pass the drug test, my name will appear on a published list of
suspended members. If it is determined that I have failed the drug test, I agree to waive any claim for which legal relief is
available. I agree to pay any 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 Sino Qua Non for the acceptance of my entry in this contest. I also certify with my signature that this
release/agreement cannot be modified orally.
Certification: I hear give my word of honor as an athlete that I have not used any strength inducing drugs (i.e. anabolic
steroid, natural hormone or synthetic growth hormones) as part of my training during the past 36 months, nor have I used
prescription diuretics or psychomotor stimulants during the seven days prior to this meet. I also certify that the information
regarding my qualifying total is accurate true information.
To be signed by Lifter, Parent/Guardian and Coach _________________________________ (Signature of Lifter)
____________ _____________________________________________ (Date)
(Team)
_________________________________
(Signature of Parent/Guardian)
____________
(Date)
_______________________________
(Signature of Coach)
__________
(Date)
2015 WHSPA STATE POWERLIFTING
PAYMENT FORM
The Payment Form, The Entry Form, Proof of Good Standing
Form, and your Payment
Must Be Postmarked By -Wednesday, March 4th, 2015
Send Entry Forms & Checks To:
ATTN: Erich Mach
Necedah Area High School
1801 S. Main
Necedah, WI 54646
This is a USAPL Sanctioned Event.
If you have any questions about the 2015 Wisconsin High School State Powerlifting Meet,
you can contact the meet director or visit our site.