UPA Utah Strength Sports Coalition 2014 Championships @ PSM

UPA Utah Strength Sports Coalition 2014 Championships
@ PSM BARBELL
Saturday, April 26, 2014
Entry Form
_____________________________________________________________________________
Last Name
First Name
Middle Initial
Address_________________________________________________________________________________________
City_____________________________________________________ State______________ Zip Code_____________
Home Phone___________________________________ Work Phone _______________________________________
E-Mail ________________________________________________________ Date of Birth_______________________
Wt. Class (Men): 114 123 132 148 165 181 198 220 242 275 308 SHW (circle one)
Wt. Class (Women): 97 105 114 123 132 148 165 181 198 Unlimited (circle one)
Division/Age Group: Open Junior (20-23) Teen (13-15) Teen (16-17) Teen (18-19)
Sub master (33-39) Masters: 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 (circle one)
□ Full Meet
□ Bench-only
Non-UPA lifters may purchase
memberships at the meet ($30 for UPA and $10
for USSC)
□ Dead lift-only
□ RAW
Full Meet Entry Fee--$60
BENCH ONLY – DEADLIFT ONLY$ 60
Additional Divisions Entry Fee--$30
UPA card=$30, USSC card=$10
Total
□ Cash payment enclosed
□ Check payment enclosed
□ Money order payment enclosed
ALL COMPETITORS MUST R.S.V.P. to: [email protected] ASAP with their name, address, phone
number, weight class, division/age group, and whether they’re full meet, bench-only, deadlift-only. Send entries via mail
to Jason Gibson (Address below). Make checks or money orders payable to: Jason Gibson.
Note: Each athlete MUST show his/her UPA membership card at weigh-in. If he/she cannot, then they will have to buy
one and their membership will be extended a year. USSC athletes MUST also have a USSC membership to compete in
this meet.
Waiver: In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors, and administrators waive
and release any and all rights and claims for damages I may have against the UPA, USSC, Jason Gibson, Ed Kinsey, and
PSM Barbell, their representatives, successors, and assigns for any and all injuries or bodily harm that I might suffer while
competing at the UPA Utah Strength Sports Coalition Championships on February 22-23, 2013.
_____________________________________
Mail entries to:
CELL # 1-801-920-4165 JASON
# 1-801-698-8003 ED
Jason Gibson
2957 WEST 4275 SOUTH
Roy, UT 84067
Signature of Competitor or Parent/Legal Guardian if
Competitor is under 18 years of age
MEET DIRECTOR:
Jason Gibson 801-920-4165 *E-mail [email protected]
Ed Kinsey 801-698-8003
*E-mail [email protected]
EVENT LOCATION:
PSM Barbell / Mori Academy
5385 S 1950 W Roy, UT 84067
ELIGIBILITY:
Open to all UPA and USSC Registered
Athletes: Must show proof of UPA card
at weigh in. All entries in UPA
sanctioned events must have a valid UPA
Registration card. Fee is $30 per card.
UPA registration for high school $15.
Registration will be available at weighins. USSC membership is $10.
WEIGH-IN:
24-HOUR WEIGH-IN RULE APPLIES
Weigh INS:
PSM Barbell / Mori Academy
5385 S 1950 W Roy, UT 84067
Friday April 25: 9-11 am, 5-6 pm
Saturday, April 26: 7- 8:30 AM
EVENT START TIME:
Saturday Aril 26th @ 10 AM
Mandatory Rules Meeting: 9:15 AM
CONTEST LIFTS:
Full Power, Bench Only, Deadlift Only
AWARDS:
Amateur: 1st-3rd in each weight class
in each division.
There will be best lifter awards by the
Schwartz Formula.
RULES:
United Powerlifting Association
(UPA). Check www.UPAPower.com
for information and rulebook.
UNIFORM:
Must have one piece lifting suit or
wrestling suit (Singlet).

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