LI STRONGEST MAN (North American Strongman Inc. Membership Required of all Contestants) PROMOTER: EDWARD COLLAKU CONTACT: Cell: 631-902-9705 EMAIL: [email protected] DATE: 10/18/2014 TIME: Start Time @ 10:00am, Rules @ 9:30am Weight in Friday Night 6:30- 8:30pm - 1511 Denver Ave. Bay Shore 11706 Day of @ Park: 8:00am LOCATION: Belmont Lake State Park Southern State Parkway Exit 38 North Babylon, NY 11703 Pine Pavilion Drive Through Main Parking Lot to Rear Parking Lot – Pine Pavilion is on the left MENS DIVISIONS/ CLASSES: 175’S, 200’S, MIDDLE WEIGHT, HEAVY WEIGHT 175 200 MIDDLE HEAVY WEIGHT WEIGHT AXLE C & P 200 220 240 260 60’S TIME LIMIT FARMERS 460 540 580 620 50 ft. 1 DROP MAX TIRE DL 3 ATTEMPTS STARTING WEIGHTS TIRE FLIP 5 FLIPS / 2 POWER STAIRS MEDLEY 60’S TIME STONE OVER BAR 48’’ 60’S TIME 400 450 500 550 600/250 600/275 700/300 700/325 240 265 300 330 AWARDS: TROPHIES FOR TOP THREE IN EACH CLASS ENTRY FEES: $60 FOR ALL ENTRIES - Includes T-Shirt ENTRY DEADLINE: None – Competition will be Capped at 50 Competitors (No Exceptions) *NOTE – NY STATE PARK – NO Alcohol – NO Pets MAKE ALL CHECKS PAYABLE TO: Edward Collaku 1511 Denver Avenue Bay Shore, NY 11706 PLEASE SEND AN APP WITH YOUR CHECK! In consideration of your acceptance of this entry, I hereby, for myself, my heirs, executors and administrators, and my assignees, waive and release all rights and damages I may have against EDWARD COLLAKU, THE PEOPLE OF THE STATE OF NEW YORK, THE NEW YORK STATE OFFICE OF PARKS, RECREATION, AND HIISTORIC PRESEVERVATION, THE LONG ISLAND STATE PARK, RECREATION AND HISTORIC PRESERVATION COMMISION, OFFICERS, AGENTS, AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED & ALL THE RECEIPANTS OF THE PROCEEDS, North American Strongman, Inc, American Strongman Corp. Willie or Dione Wessels, Expo, any and all sponsors of the event, their representatives and assigns, for any and all injuries incurred by me in conjunction with these championships and in traveling to and from the event. And in further consideration of permission being granted to me to participate in the LONG ISLAND STRONGEST MAN and its related events, I hereby grant NAS INC., and/or any other 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 any and all media, including without limitation, by means of still photography, motion pictures, radio, television, television motion pictures, video, printing 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 anytime in connection therewith. Nothing contained herein shall be deemed to obligate NAS INC., and/or any other 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 NAS INC. and/or any other 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 NAS INC. and/or any other approved video or entertainment organization hereunder. Therefore I affix my signature below: NAME: __________________________________________________________________________________________ AGE: _____________ ADDRESS:__________________________________________________________________________________________________________ CITY: ___________________________________________________________________STATE: _____________________ ZIP: __________ PHONE: _____________________________________________________ DATE OF BIRTH:_______________________________________ EMAIL: ______________________________________________________________________________________________________________ WEIGHT CLASS: ______________________________________ T-SHIRT SIZE:_____________________________ SIGNATURE:______________________________________________________________________________________________________________ _________ ____ (PARENT OR GUARDIAN SIGNATURE REQUIRED IF CONTESTANT IS UNDER 18 YEARS OF AGE)