ENTRY FORM FOR

18th Annual USAPL IDAHO STATE & OPEN CHAMPIONSHIPS

Powerlifting Championships and "BAD ASS" BENCH PRESS MEET!

November 21, 2009

MUST BE POST-MARKED NO LATER THAN NOVEMBER 1st, 2008 WITH

PAYMENT OR $15.00 NON-REFUNDABLE DEPOSIT ENCLOSED

THERE ARE RAW STATE RECORDS READY TO BE SET

IN ALL WEIGHT CLASSES AND DIVISIONS!!!

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MAIL ENTRIES TO: FITNESS INC. HEALTH CLUB C/O Bill Davis
 1800 Garrett Way #19 . Pocatello, ID. 83201
 Phone (208) 233-8035, Fax (208) 233-8430
 
Make checks payable to: Fitness Inc.
 
Name: _____________________ Phone #: ____________________________ 
 
Address: _____________________________ Weight Class: ______ Age:____ 
 
City: _____________________________ Shirt Size: S M L XL XXL XXL
 
State, Zip:_____________________________ Male/Female: _______ 
 
Divisions: Open Men_____ Open Women___ Masters (over 40)_____ 
 
Collegiate _____Teenage______ RAW:______________  
 
Entering: Check ONE AND ONLY ONE of following:
 
[ ] Full 3-Lift Meet 
[ ] Bench Press Only 
[ ] BOTH 3-Lift Meet AND Bench Meet 
 
In consideration of your acceptance of this entry I hereby, for myself, 
heirs, executors, or administrators waive and release any and all 
claims of damages, or injuries I may have against FITNESS INC., the
sponsoring organizations of whatever kind, their agents or representatives 
for any and all injuries sustained by me in the U.S.A.P.L. competition.
By my signature, I acknowledge reading and understanding the implications of
this clause.
 
Signature of Entrant:________________________________  
 
Signature of parent
 or legal guardian: _________________________________

Here is the MAP to help you find easy access to Fitness from Freeways and also to find the hotels: BEST WESTERN COTTONTREE INN, 1415 Bench, Pocatello ID (1-208-237-7650) which is located just off of exit 71 on Interstate-15!