Entry Form and Information Package

Transcription

Entry Form and Information Package
NJ NPC MID ATLANTIC
NATURAL CLASSIC
BODYBUILDING  PHYSIQUE  FIGURE  BIKINI
COMPETITION
Location: New Brunswick Middle School
1125 Livingston Avenue
New Brunswick 08901
Entry Form & Information Packet
UPDATES FOR 2015
√ NO DAY OF COMPETITION ENTRIES
ACCEPTED
√ CHECK- IN, WEIGHT -IN & NPC CARDS
– FRIDAY, MAY 1 @ 6:00 PM
MUSCLE MILL - 23 NO MAIN ST, MILLTOWN, NJ
A Ron Capodanno Production
23 North Main Street, Milltown, NJ 08850
(732) 828-4004
www.RonsWorldFitness.com
[email protected]
MIDATLANTIC NATURAL CLASSIC
ENTRY FORM
MAY 2, 2015 
NEW BRUNSWICK MIDDLE SCHOOL
FULL NAME:
EMAIL:
ADDRESS:
PHONE:
CITY:
TRAINING GYM:
STATE:
AGE:
ZIP:
WEIGHT/HEIGHT:
TITLES/HOBBIES/ACCOMPLISHMENTS:
Men

Women
crossover ?
NOVICE MEN BB
 B
(SELECT DIVISION/WEIGHT CLASS)
C
D

 A
E
OPEN MEN BB *NQ (SELECT DIVISION/WEIGHT CLASS)


MEN’S MASTERS BB – OVER 35


MEN’S MASTERS BB – OVER 45


MEN’S BB FIRST TIMERS (NEVER COMPETED)

 A


 B
MEN’S PHYSIQUE
C
D
E
**NQ
MEN’S MASTER PHYSIQUE *NQ – 35 & OVER



OPEN AND NOVICE MEN (OPEN MEN’S IS A *NATIONAL QUALIFIER)
A. BANTAM (OPEN ONLY): UP TO 143 ¼
B. LIGHTWEIGHT: 143 ¼ UP TO AND INCLUDING 154 ¼
C. MIDDLEWEIGHT: OVER 154 ¼ UP TO AND INCLUDING 176 ¼
D. LIGHT HEAVYWEIGHT: OVER 176 ¼ UP TO AND INCLUDING 198 ¼
E. HEAVY WEIGHT: 198 ¼ AND OVER
Teens

TEENS – MEN’S BODY BUILDING

TEENS – MEN’S PHYSIQUE
*NQ = NATIONAL QUALIFIER
** = CLASSES TO BE DETERMINED DAY OF
EVENT
C
WOMEN’S PHYSIQUE BB
 B
BIKINI – UNDER 5’4”
BIKINI – 5’4” & OVER
*NQ (SELECT DIVISION/WEIGHT CLASS)
*NQ
*NQ
WOMEN’S MASTERS BIKINI ** —35 & OVER
WOMEN’S FIGURE – UNDER 5’4”
WOMEN’S FIGURE – 5’4” & OVER
*NQ
*NQ
WOMEN’S MASTERS FIGURE – 35 & OVER
WOMEN’S PHYSIQUE *NATIONAL QUALIFIER
A. UNDER 5’4”
B. 5’4” & OVER
ENTRY FEE (PER DIVISION)
***NO Refunds***
1 Class Early by April 21 $6000
2 Classes:
$11000
3 Classes:
$17000
After April 22nd:
$75.00 per class
No Day of Show ENTRIES
A RON CAPODANNO PRODUCTION
Page 1 of 5
MID-ATLANTIC NATURAL CLASSIC
ENTRY FORM
MAY 2, 2015 
NEW BRUNSWICK MIDDLE SCHOOL
In consideration of being allowed to participate in any way in the 2015 NPC Mid Atlantic Natural Classic (“Event”)
promoted by A Ron Capodanno Production (“Promoter”) and sanctioned by the National Physique Committee of the
USA, Inc. (“NPC”), its related events and activities, I, Please print name_____________________________________________________),
the undersigned, acknowledge, appreciate and agree that: The risk of injury from the activities involved in this Event
is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and
personal discipline may reduce this risk, the risk of serious injury does exist; and, I KNOWINGLY AND FREELY ASSUME
ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE PROMOTER AND/OR THE
NPC or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated
and customary terms and conditions for participation, if, however, I observe any unusual significant hazard during my
presence or participation, I will remove myself from participation and bring such to the attention of the Promoter
immediately; and ,I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Promoter and the NPC and each of their officers, officials, agents
and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and
lessors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY DISABILITY, DEATH, or
loss or damage to person or property associated with my presence at or participation in or in traveling to and from
the Event, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent
permitted by law. The undersigned further consents and agrees that the undersigned will comply with all rules and
regulations of the Name of Hotel - Not Applicable (“Hotel”) including any rules or regulations prohibiting cooking or
food preparation in the hotel rooms. The undersigned further agrees that the undersigned will indemnify and hold
harmless the NPC and the Promoter from and against any damages caused by the undersigned to the Hotel or
damages to a guest room or rooms occupied or registered to the undersigned. Finally, the undersigned acknowledges
that the undersigned’s failure to comply with any rule or regulation of the Hotel or damage to any guest room
occupied by or registered to the undersigned may result in disciplinary action against the undersigned including, but
not limited to, suspension as a member of the NPC and/or competing in contests sanctioned by the NPC. And in
further consideration of permission being granted to me to participate in the Event and its related events. I hereby
grant the NPC, Promoter and/or any other NPC-approved video or entertainment organization and all of their
agents, successors, licensees and assigns, the right to photograph or otherwise reproduce (whether by _lm, tape,
still photography or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit, and/or otherwise
exploit any and all media, including without limitation, by means of still photography, motion pictures, radio,
television, television motion pictures, video, printing on digital or any other medium now known or hereafter devised,
including with respect also to any merchandising, advertising and/or publicity, and the right to use my name and
information about me in any connection with any of the foregoing. The rights granted by me hereunder are granted
for the entire universe and shall endure in perpetuity and no further compensation shall be payable to me at any time
in connection therewith. Nothing contained herein shall be deemed to obligate the NPC, Promoter, and/or any other
NPC-approved video or entertainment organization, to photograph or otherwise reproduce my voice, appearance or
name, or to make use of any rights granted herein. I also understand that the aforementioned rights may be
reassigned at any time without further consent. I understand that the NPC, the Promoter and/or any NPC-approved
video or entertainment organization, are videotaping and photographing the Event in express reliance upon the
foregoing, and I represent and agree that I am free to grant the rights granted to the NPC, Promoter and/or any
other NPC-approved video or entertainment organization hereunder. I HAVE READ THIS RELEASE OF LIABILITY AND
ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP
SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
X____________________________________________________________ Age: ___ __ Date SIGNED: __________
PARTICIPANTS SIGNATURE
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to
his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of
kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor
child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE
OF THE RELEASEES, to the fullest extent permitted by law.
X_____________________________________________________________ Age: _____ Date Signed: ____________
PARENT/GUARDIAN SIGNATURE
A RON CAPODANNO PRODUCTION
*IMPORTANT INFORMATION*
KEEP THIS PAGE!!!!!!!
TO ENTER:
Send MONEY ORDERS ONLY (Checks will be returned!)
Payable to:
RON CAPODANNO
23 North Main Street
Milltown, NJ 08850
(732) 828-4004
[email protected]
DATES /TIMES/ LOCATIONS
SHOW DATE
MAY 2, 2015
EARLY ENTRY DEADLINE
April 21
POLYGRAPH TESTING
ALL CONTESTANTS ARE
REQUIRED TO BE
POLYGRAPHED
(see page 4 for scheduling info)
WEIGH-IN & NPC CARDS
(BRING TRUNKS)
PREJUDGING
NIGHT SHOW
FEES
April 28, 29, 30 & May 1
May 1
May 2
May 2
10:00 AM– 8:00 PM
World Fitness/Muscle Mill
6:00 PM –9:00 PM
Muscle Mill
9:00 AM Competitors
Arrive at Venue
11:00 AM SHARP Begins
New Brunswick Middle School
5:00 PM Doors Open
6:00 PM Show Begins
New Brunswick Middle
School
ENTRY (*Per Division*) NO Refunds
$60 Early per class
$75 After April 21 per class
NPC CARD (May purchase on day of event)
$120 (Annual)
POLYGRAPH TESTING (Due at testing time)
REMEMBER - ALL COMPETITORS MUST BE POLYGRAPH TESTED
$45
 EVERYONE MUST HAVE AN NPC CARD
 BRING YOUR TRUNKS & SUITS TO WEIGH-INS at Muscle Mill- May 1st 6PM
 MAKE SURE YOUR TAPE OR CD IS CUED UP & LABELED MINUTE LENGTH.
(NO PROFANITY!!)
 TEENS AND MASTERS MUST BRING PROOF OF AGE!!
A RON CAPODANNO PRODUCTION
PAGE 3 OF 5
-IMPORTANT INFORMATION-
**KEEP THIS PAGE**
LOCATION:
**KEEP THIS PAGE**
New Brunswick Middle School
1125 Livingston Avenue, New Brunswick, NJ 08901
DRUG TESTING REQUIREMENTS - COMPETITORS SCHEDULE THEIR OWN POLYGRAPH TEST
at https://npc2015midatlantic.acuityscheduling.com/schedule.php
or contact Chris at 917-560-3196
NOVICE (Pure Class):
OPEN MEN:
WOMEN’S PHYSIQUE
& MEN’S PHYSIQUE:
WOMEN’S FIGURE
& BIKINI:
AWARDS:
For novice men’s weight class ONLY. To compete, you must be
tested as free from steroid and diuretic use for (5) Years or more
from the date of the show.
To compete, you must be tested as free from steroid and diuretic use
for (1) year or more from the date of the show.
To compete, you must be tested as free from steroid and diuretic use
for (3) years or more from the date of the show.
To compete, you must be tested as free from steroid and diuretic use
for (1) year or more from the date of the show.
All competitors
First 5 places
Official show T-shirt
Neils Anderson Statue
(in each class)
OVERALL Awards
MEDIA:
Show Jacket
Open Men
OVERALL Winner $250.00 toward travel expenses to
the 2015 Team Universe
Publication in Ironman Magazine, NPC News, and others.
Tanning, Makeup and Competitor Preparation will be done BY Gina Trochiano at
DESTINATION GLAM SQUAD at her location or on Friday, May 1st 12 PM- 9:00 PM and
Saturday May 2nd 5-9:00 AM at Muscle Mill For Pricing, Details and to Book your
appointment, log onto : DestinationGlamSquad.com
SHE IS THE OFFICIAL TANNING AND MAKEUP SERVICE FOR THE EVENT.
A RON CAPODANNO PRODUCTION
Page 4 of 5
TICKET PRICES
**PRE-SHOW TICKET SALES AT MUSCLE MILL/WORLD FITNESS**
732-828-4004
LOCATED AT: 23 NO. MAIN STREET
MILLTOWN, NJ 08850
Platinum VIP
$60.00
VIP
$45.00
Prejudging Only
$25.00
A & B Rows CenterDirectly Behind Judges
(includes prejudging) ONLY 25 Available!!
General Admission
Backstage Pass
P/J-G/A-Ticket
$35.00
$70.00
Rows C-M (includes prejudging)
Rows N and back (Night Show)
No advance sales – At door only
Backstage/Prejudging/General Admission
IMPORTANT – PLEASE READ
Advance ticket orders must be received by April 22, 2015. Money Order Only (made payable to
Ron Capodanno) and a self-addressed, stamped envelope. Also, include a note with a list of the
services you will be paying for. NO CHECKS Mail to RON CAPODANNO, 23 North Main Street
Milltown NJ 08850. Tickets may also be purchased in person at World Fitness at above address.
For BACKSTAGE PASSES you will need to give us the person’s FULL NAME with PAYMENT IN
FULL. Only One Person will get a Backstage Pass. Their Badge will be at the Credential’s Table and
it will be under the Competitor’s name. The Backstage Pass is a Badge and is for the backstage, as
well as their ticket for the whole day of the Event . If they lose it, there is a $25.00 Charge for a new
one, along with proper ID to show it was the person that it was ORIGINALLY handed to.
REMEMBER—NPC Cards DO NOT get sent to us. POLYGRAPH TEST gets paid at time of test!!!
You need Only ONE Money ORDER for your Entry Form, Tickets, & Backstage Passes.
A RON CAPODANNO PRODUCTION
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