Entry Form NSPL Provincials 2015

NSPL PROVINCIALS 2015
Date:
Saturday, May 23, 2015
Location:
Sackville Sports Stadium
409 Glendale Drive
Lower Sackville, NS
Entry Limit:
56 Powerlifting, 14 Bench (4 Flights Powerlifting, 1 Flight Bench Only)
Times:
MORNING FLIGHTS
Powerlifting Weigh in:
Lifting Begins
6:00 AM
8:00 AM
AFTERNOON FLIGHTS (approximate)
Powerlifting Weigh in:
12:00 PM
Lifting Begins
2:00 PM
Rules:
All International Powerlifting Federation (IPF) rules will be followed, for
a list of technical rules visit http://powerlifting-ipf.com/50.html , for a
list of approved items visit http://powerlifting-ipf.com/51.html
Entry Fee:
Regular Members
High School & Special Olympians
$60 – Powerlifting
$50 - Powerlifting
$40 – Bench Press
$30 – Bench Press
$85 – Both
$65 – Both
Doping Control: The CPU follows the rules and regulations of the World Anti-Doping Agency
(WADA). By competing in this competition, you accept the possibility of being selected for
doping control. There WILL be testing at this event.
Meet Director:
Ryan Kells- 902-266-7229 – ryankells@hotmail.com
Entry Deadline:
Postmarked by May 1, 2015. Late Entry Fee of $30 will apply
Please Note:
This is a CPU sanctioned event. 2015 CPU cards are required for all
lifters and are available to purchase on-line at www.powerlifting.ca. The CPU follows the
anti-doping rules and regulations of the WADA code. Please refer to the CPU Constitution
regarding anti-doping policies. (www.powerlifting.ca)
NSPL PROVINCIALS 2015
(print clearly)
NAME: _________________________________________ ______________________CPU CARD #:________________________
ADDRESS:_____________________________________________________________POSTAL CODE:_______________________
CITY:____________________________________________________________________________________________________
PHONE:_______________________________________________ Qualifying Total:____Not Applicable____________________
EMAIL:__________________________________________________________________________________________________
DATE OF BIRTH:___________________________________________________________________________________________
AGE CATEGORY:__________________________________________________________________________________________
SEX:
M
F
T-SHIRT SIZE: ____________
EVENTS
(Please check)
EQUIPPED POWERLIFTING____
EQUIPED BENCH_____
CLASSIC POWERLIFTING______
RAW BENCH_________
WEIGHT CLASSES
(Please circle)
WOMEN:
43kg, 47kg, 52kg, 57kg, 63kg, 72kg, 84kg, 84kg+
MEN:
53kg, 59kg, 66kg, 74kg, 83kg, 93kg, 105kg, 120kg, 120kg+
TOTAL ENCLOSED
Entry Fee:
$____________
CPU Doping Control Fee:
$20 (required)
MONEY ENCLOSED:
$ _________________
Mail cheques & Entry Forms to:
Nova Scotia Powerlifting
2519 Philip St.
Halifax, NS
B3L 3H1
Please make cheques payable to Nova Scotia Powerlifting
WAIVER FORM
In consideration of accepting this entry, I hereby for myself, heirs, executors and administrators, waive and release any and all rights and
claims for damages I may have against: the International Powerlifting Federation, the Canadian Powerlifting Union, the Nova Scotia
Powerlifting Association and Executive, the Sackville Sports Stadium, the meet/contest site, sponsor and it's employees, all organizers,
volunteers and sponsors of this contest, from any and all actions, causes of actions, claims and demands which may arise in consequence of
my participation in this contest. I realize that Powerlifting is a high risk sport and that I could be injured. I certify that I am in good physical
health and that I have no serious health problems and that I assume full responsibility for such conditions. I accept that I am fully
responsible for my well being and safety in the warm up room, on the lifting platform and while I am competing at this event. I am also
aware that I am responsible for the actions of any coach and entourage that attend this contest in my support. I also certify by my signature
that I have read this waiver and fully understand and accept its terms. I do hereby verify my acceptance of these terms by my signature
below.
Signature:________________________________________________________
Parent / Guardian (if under 18)________________________________________
Date:_____________________________________________________________