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Sanction
12804
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Saturday, 11 April 2015
Davenport West High School
NPC National Qualifier
Richard “TRICKY” Jackson, IFBB Pro, Louisville, KY
2015 NPC MIDWEST OPEN & NOVICE BODYBUILDING
Fitness/Figure, Bikini, Women & Men Physique Championships
Overall Winners Receive - Muscle Classic Jackets, Trophies 1st – 5th in class,
Team Trophy – Most Competitors & Placing from the same gym, Figure Class – 35 & over National Qualifier
& Bikini Class – 35 & over National Qualifier
SOLEIL AIRBRUSH COMPETITION TANS – Cameo Lasasso (563) 508-0878 - $130 – Two Tans & Touchups - $10 - Glaze
ORDER TICKETS EARLY through [email protected]
Please visit our website www.npciowamuscle.com
(Please Print Clearly)
Official Use Only
NAME ______________________________________ HOME PHONE _______________________
Official
Weight _______ Exp. ______
ADDRESS ___________________________________ WORK PHONE ______________________
CITY ______________________________________ STATE ________ ZIPCODE ____________
Division __________________
E-MAIL ____________________________________________________________________________
AGE OR WEIGHT CLASS EXPECTED __________________ T-SHIRT SIZE _______
Class __________ # ________
BIRTH DATE _____________ GYM REPRESENTING _________________________________
List Any Other Information You Would like the MC to Say _________________________________________________
________________________________________________________________________________________________
__________________________________________________________________________________________________________
In consideration of being allowed to participate in any way in the Name of Event BIG BEA EVENT (“Event”) promoted by Name of Promoter ERNEST BEA, JR. (“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: 1. 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, 2. 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 2. 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 4. 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 _________________ (“Hotel”) including any
rules of 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 quest 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 film, tape, still photography or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit, and/or otherwise exploit 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 GIVE UP SUBSTAINTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY
WITHOUT ANY INDUCEMENT.
X__________________________________________________________ Age: __________ Date Signed: ___________________________________
PARTICIPANTS SIGNATURE
FOR PARENTS/GUARDIANS OR 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 OR GUARDIAN SIGNATURE
COMPETING In: Crossovers allowed. First entry $85 and Second entry $75.
(May purchase NPC card at check-in for $120.00)
Entry Fee:
Open or Masters $85.00
** Circle your Division and Check your Class **
Send signed Entry Form with Proper Fee(s) to: Ernest Bea, Jr., 1020 14-1/2 Street, Rock Island, IL 61201
Midwest
Midwest
Midwest
Midwest
Teenage
Men
Masters Men
Women
Master Women
Master Figure Class
Short Under 5’4”
Med Over 5’4” – 5’7”
Tall Over 5’7”
Bikini Class
Short Under 5’4”
Med Over 5’4” – 5’7”
Tall Over 5’7”
Master Bikini Class
Short Under 5’4”
Med Over 5’4” – 5’7”
Tall Over 5’7”
Figure Class
Short Under 5’4”
Med Over 5’4” – 5’7”
Tall Over 5’7”
Women Physique
Short Under 5’4”
Med Over 5’4”- 5’7”
Tall Over 5’7”
Men Physique
Short Under 5’8”
Med Over 5’8 – 6’
Tall Over 6’
Fitness Class
Short Under 5’7”
Tall Over 5’7”
Men Master Physique
Short Under 5’8”
Med Over 5’8 – 6’
Tall Over 6’
Entry must be mailed on or before 31 March to avoid a $70.00 late fee.
Entrees will be accepted the day of competition with late fee!!!
TO RECEIVE CONFIRMATION OF ENTRY DON’T FORGET TO PUT EMAIL ADDRESS ON APPLICATION
DATE:
Saturday, 11 April 2015
TIME:
Check-in ONLY Friday, April 10 between 5:00 p.m. to 8:00 p.m. @ Ramada Inn, I-74 &
Spruce Hills Drive, Iowa Exit 2. 3020 Utica Ridge Road, Bettendorf, IA 52722
Mandatory Meeting 8:00 a.m. the day of show @
Davenport West High Auditorium
For All Competitors * Pre-Judging 9:30 a.m. * Evening Show 5:00 p.m. Sharp!
PLACE:
CONTEST
DIRECTOR:
Davenport West High School Auditorium, 3505 West Locust Street, Davenport, IA 52804
ERNEST BEA, JR., 1020 14-1/2 STREET, ROCK ISLAND, IL 61201 1-309-793-5920 OR
1-309-793-0020 OR E-mail: [email protected]
DIVISIONS:
OPEN: MEN: 6 Classes: Bantam weight – 143-1/4 and under, Lightweight – over 143-1/4 and up to
including 154-1/4, Middleweight – over 154-1/4 and up to and including 176 –1/4, Light Heavy – over
176-1/4 and up to and including 198-1/4, - Heavy weight over 198-1/4 up to and including 225-1/4,
Super Heavy Weight over 225-1/4 OPEN WOMEN: 3 Classes: Light weight – 118 and under, Middle
weight – over 118 lbs. And up to and including 132 lbs., Heavy weight over 132. MASTERS (Men): 35 39 years old, 40-44 years, 45-49 years old, 50-59 years old, 60-69 years old & over 70. MASTERS
(WOMEN): 3 Classes: 35-39 years old, 40-49 years old, & 50 and over TEENAGE: 1 Class 13 to 19 years
old. MIDWEST OPEN: OPEN TO ALL COMPETITORS. FITNESS: 2 Classes; FIGURE: 3 Classes; and
BIKINI: 3 Classes MASTER BIKINI – 2 Classes MASTER FIGURE – 2 Classes
WOMEN PHYSIQUE: 3 Classes – Short: Under 5’4”, Med: Over 5’4” – 5’7” & Tall: Over 5’7”
MEN PHYSIQUE: 3 Classes – Short Under 5’8”, Med: Over 5’8” – 6’0”, & Tall: Over 6’0”
MASTER MEN PHYSIQUE: 3 Classes, 35 & older – Depending on entries
ELIGIBILITY:
ALL COMPETITORS: (1) Each competitor must be currently registered with the NPC and to meet this
requirement, he/she Must present his/her current NPC card, current NPC receipt, or purchase an NPC
card at this competition ($120). OPEN MEN & WOMEN: Any competitor who has won a higher level
overall title, or who is nationally qualified by virtue of his/her placing in a National-level competition and
who has won this overall title is not eligible to compete in this competition. INVOICE: Each competitor in
these Divisions also must not have placed in the top five places in the Men’s or Women’s Divisions in a
national-level competition; MASTERS MEN & MASTER WOMEN: 11 April 2015 must have reached
his/her 35th birthday but not his/her 40th birthday for the 35-39 year old class, his/her 45th birthday for
the 40-44 class, 50th birthday for 45-49 class, 60th birthday for 50-59 class. MASTER FIGURE &
MASTER BIKINI must be 35 or older.
Each competitor must provide proof of age with birth certificate, driver’s License or State I.D.
AWARDS:
ALL DIVISIONS, ALL CLASSES: Top 5 class winners receive Trophies. OVERALL WINNERS RECEIVE:
Custom Title Jacket * Overall Custom Trophy.
RULES:
Light oil permitted. NO HOT STUFF OR ANALGESIC SPRAYS ALLOWED. (NO EXCEPTION.) NO
BOTTLED TANNING LOTION ALLOWED IN BUILDING. PLEASE HAVE YOUR TANNING
PREPARATION DONE BEFORE YOU ARRIVE. Any contestant who competes in pre-judging Must
compete in evening show. Solid color posing suits only. No jewelry will be worn. All athletes must
exhibit good sportsmanship at all times (including award presentation). NO ONE WILL BE ALLOWED
BACKSTAGE EXCEPT COMPETITORS AND CONTEST OFFICIALS, BUT A PACKAGE CAN BE
PURCHASED FOR $100.00 (INCLUDE PREJUDGE, EVENING SHOW TICKETS ALONG WITH BADGE
FOR TRAINERS BACKSTAGE. Current NPC rules will apply.
MUSIC:
All contestants will provide their own music. All music must be pre-recorded on high quality CDs for
their own individual Posing routine. Music should be 60 seconds. (NO CDs will be played that have more
than ONE recording). One CD is required. Free posing in the evening show will be 60 seconds with
music. (NO PROFANITY OF ANY SORT – NO EXCEPTIONS)
MOTEL:
Ramada Inn: I-74 & Spruce Hills Drive, Iowa Exit 2 (563) 355-7575. 3020 Utica Ridge Road,
Bettendorf, IA. You must make hotel reservations on or before March 31, 2014 to be
guaranteed accommodations.
VIDEO:
Private Video Taping will be allowed.
2015 NPC MIDWEST OPEN & NOVICE BODYBUILDING FITNESS/FIGURE, BIKINI,
WOMEN & MEN PHYSIQUE CHAMPIONSHIPS TICKET ORDER FORM
Judging: 9:30 a.m.
$ 20.00 General Admission
Evening Show: 5:00 P.M.
**SPECIAL**
$40.00 Reserved Seating
Make Check or M.O. payable to:
A BIG BEA EVENT
1020 14-1/2 STREET
ROCK ISLAND, IL 61201
Save $5 when you purchase both Pre-judge & Evening Show Tickets In ADVANCE!!
NAME _________________________________________________
Children under 10 yrs of age tickets are $10.00
ADDRESS______________________________________________
Pre-Judging Tickets ______ at $ ________ ea.
CITY ____________________________ ST _______ ZIP ________
No. of Evening Tickets ______at $ ______ ea.
PHONE (
TOTAL AMOUNT ENCLOSED $ __________
) __________________________________
E-MAIL: ________________________________________________
To Insure Proper Delivery Allow Two Weeks for Delivery
NO REFUNDS OF ANY KIND – NO EXCEPTIONS
Ernest Bea, Jr.
1020 14-1/2 Street
Rock Island, IL 61201
Ernest Bea, Jr.
Promotor & IFBB Pro Judge
Stamp
Richard “Tricky” Jackson
IFBB Pro

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