2001 Pennsylvania State Championships
Sanction # 2-01-3
Official Entry Form
February 24 - 25th, 2001

Age:________Date of Birth_____/_____/_____Wt. Class________Sex_________

Name___________________________________________________________

Address: Street___________________________________City__________________________________

State_____ZIP__________Phone(___)______________________EMAIL______________________________
 
 

Check All Divisions entered:	Men	Women
Open	___	___
Teenage	___	___
Master	___	___
Collegiate	___	___
Out of State	___	___

**All lifters who are registered in a state outside Pennsylvania must enter the Out of State division!! The only exception is the collegiate division.

Certification
 

I give my word of honor as an athlete that I have not used any strength inducing drugs (i.e. any anabolic steroid, natural hormone or synthetic growth hormone) as part of my training during th past 36 months, nor have I used prescription diuretics or psychomotor stimulants during the seven days prior to this meet.
 

___________________________ 
Signature of Contestant
 

Release from Liability
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 director 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, whom 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 Contestant

___________________________ Signature of Parent or Legal Guardian if the contestant is under 21 years of age

Application fee: $40
****Must be postmarked by February 10th. Late entry fee $70 No entries excepted past February 16th****

Mail Entry Form & Fee to: Steve Mann
50 Rinaldi Blvd. Apt 2C
Poughkeepsie, NY 12601

Limit of 150 entries, send your applications in soon.
 
 

In Conjunction with EAST HALLS GYM
Quest  Nutrition  Supplements