Entry-Form-USAPL-ESF-HS-PL-Open

2nd Annual USAPL Elite Sports and Fitness
High School Powerlifting Open
Sanctioned By: USA Powerlifting (USAPL) Sanction# MA-2015-03
Meet Director: Zac Cooper
Date, Time, Place: Sunday, February 8, 2015 at 9:00 a.m. at Elite Sports and Fitness 206 South Main
Street, Middleton Mass 01949
Eligibility: Open to ALL USAPL Junior High School and High School registered athletes, 12-19 years old
who have been drug free for at least 3 years. At least 10% of the lifters will be drug tested. All athletes
must have a valid USAPL Registration Card. The 2015 USAPL registration fee is $15.00 for high school
seasonal (HS only division for 6 mos.) or $35 for high school full year (any meet). No qualifying totals
required. Athletes must register for their USAPL membership prior to the meet online at
http://www.usapowerlifting.com/forms/MembershipApplication.php
Uniforms: One piece lifting suits are mandatory for all contestants (singlets). As well as nonsupportive briefs without legs (not boxers, or boxer-briefs) for competition and weigh-ins. ALL
equipment must conform to USAPL standards, supportive suits, shirts and wraps must manufactured
by Inzer, Titan, SBD or Metal all others are not allowed. For further clarification please visit
www.usapowerlifting.com/committees/technical or contact the meet directors.
Contested Lifts: Squat, Bench, and Deadlift (Full Meet) with three attempts in each. USAPL rules will
govern the meet. For further clarification refer to the USAPL rulebook or consult the National Office at
(260) 248-4889 or visit http://www.usapowerlifting.com/lifterscorner/USAPLHandbook2.pdf
Weight Classes (lb) Men's:
116 – 130 – 145 – 163 – 182 – 205 – 231 – 264 – 264+
Women’s: 94 – 103 – 114 – 125 – 138 – 158 – 185 – 185+
There will be a JV and Varsity division in both Raw and Equipped. JV will consist of junior high school,
freshman, and sophomores while the Varsity will be juniors and seniors. There will also be a High
School Special Olympics Division.
Weigh-In Times: All divisions will be weighed-in on Saturday between 7:00-8:30 AM. Rules briefing
will follow at 8:30 AM. All times subject to change!
Drug Testing: There will be a urinalysis test given and a release form to be signed by each and every
contestant tested. Failure to submit to and/or passing the drug test will result in DISQUALIFICATION.
General Admission: $5.00 at the door for all spectators and personal coaches
Send Entries & Make Checks Payable to: Zac Cooper
WEBSITE: for on-line entry and up to date information: www.mass-lift.com
MEET DIRECTORS: Zac Cooper Tel. 985-687-1607 or [email protected]
2nd Annual USAPL Elite Sports and Fitness
High School Powerlifting Open
Name_________________________________________________ E-mail: ____________________________________
(Please print E-mail clearly)
Address: _____________________________________________ City: _______________ State: ____Zip Code: ________
Cell Phone: (
) __________________
Home Phone: (
) ______________________
Weight Class that you will be lifting in: __________Age: ______ Date of Birth: ___/____/______ Gender: M / F
USAPL Membership Card #: _______________ Expiration Date: ______________ Powerlifting Club______________
(Must be purchased online – see pg1)
RELEASE FROM LIABILITY AND CONSENT TO DRUG TEST:
Read this carefully (When you sign it you will be giving up important legal rights)
In consideration of the acceptance of my Entry Form 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,
including any result of negligence, which may arise from this competition. Moreover, I agree that any testing method, which the meet directors and the sponsors
of this meet use to detect the presence of strength inducing drugs, SHALL BE CONCLUSIVE. This is, whether I think the results of the test 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 test, which may be necessary to complete the drug
testing. Should I fail to pass the drug tests I agree to forfeit any trophy or award, which I might otherwise have won. I understand and agree that if I fail to pass
the drug tests, 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 by any person, real or corporate, which 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 acceptance of my entry in
this contest. If any provision of this Release from Liability shall be deemed by a court of competent jurisdiction to be invalid, the remainder of this Release from
Liability shall remain in force and effect. I also certify with my signature that this release/agreement cannot be modified orally.
Signature of lifter
Signature of Parent
Or Legal Guardian
Date
If Contestant is under 18
Date
Check the Divisions you will be lifting in:
Raw
Junior Varsity (All Junior High, Freshman & Sophmores)
Varsity (Juniors & Seniors)
Special Olympian
Weight Class (lb) ___________
Equipped
Be sure to select Raw or Equipped
All entries received without this
checked will be assumed as raw!!
(see pg1 for wt. classes)
ENTRY FEE (S):
________$50.00 – Full Powerlifting Competition [Squat, Bench Press and Deadlift]
________$50.00 – Bench Press Only Only Competition
________$50.00 – Push/Pull only Competition [Bench Press and Deadlift]
________$30.00 – Each additional division entered per competition (see above)
________$50.00 – Team Entry Fee (please see Team Entry Page)
________$40.00 – Late Fee if competition entry form is post-marked after January 30, 2015
________Total Enclosed
APPLICATIONS MUST BE POSTMARKED BY NO LATER THAN FRIDAY, JANUARY 30, 2015
Important Note: If your application/entry form is late, you MUST notify the meet director either by e-mail or telephone. There are no
refunds for any reason after Friday, January 30, 2015. The late fee will apply to everyone.
CHECK OR MONEY ORDERS PAYABLE AND MAILED TO THE FOLLOWING:
Zac Cooper – Contest Director
107 Winter Street Leominster, MA 01453
Telephone: 573.985.1607 * E-mail: [email protected]
Must be post-marked no later than FRIDAY, JANUARY 30, 2015
Online entry and up to date information: www.mass-lift.com
2nd Annual USAPL Elite Sports and Fitness
High School Powerlifting Open
FULL TEAM NAME:___________________________________________________________________
HEADCOACH: ___________________________TEAM MANAGER: ___________________________
PHONE: ______________________USAPL Team Registration Number: ________ Expiration: ______
TEAM ENTRY FEE
Team entry fees are $50.00 for each division (e.g., one men's and one women's team would be $50.00 each totaling $100.00).
Additionally, each team member must fully complete an individual entry form and forward the appropriate entry fees.
TEAM ROSTER
No.
Lifter
Weight Class
USAPL Card #:
1
2
3
4
5
6
7
8
9
10
11
ALTERNATES
1
2
TEAM SCORING
Each team is allowed a maximum of 11 lifters spread throughout the range of the 11-bodyweight categories for men, and 10 lifters throughout the range of 10
bodyweight categories for women. Each team is allowed a maximum of five alternates. These alternates may be substituted at any time prior to the
commencement of the championship. Team scoring will be calculated in accordance with USAPL/IPF rules.
All Teams must be registered with USA powerlifting via a club membership application.
* ALL FINAL TEAM ROSTERS MUST BE RECEIVED BY 7:00 AM THE MORNING OF SATURDAY, FEBRUARY 8, 2015.
* PRELIMINARY ROSTER AND TEAM FEE MUST BE POST MARKED NO LATER THAN FRIDAY, JANUARY 30, 2015.