2015 UPA/UPA-AD Michigan State Powerlifting Championships Raw, Equipped & CrossFit Saturday, March 14, 2015 2016 Arnold Qualifier Meet Director: JJ Thomas-734-642-7877 or [email protected] or on Facebook.com under 2015 UPA/UPA-AD MI State Powerlifting Championships Events: Equipped & Raw: Full Power, Ironman, and Squat, Bench & DL only. CrossFit(Raw Rules apply) Place: Detroit Barbell. 24787 Van Horn. Flat Rock, MI 48134 Lifting Session: Saturday, March 14, 2015 @ 9:00am. Updates will be posted on Facebook.com, under 2015 UPA/UPA-AD Michigan State Powerlifting Championships Sanction/Rules: Sanctioned by the United Powerlifting Association (UPA) Check www.UPAPower.com for information and rulebook. UPA-AD is a drug tested division. We will be drug testing this division One piece lifting suit required. Equipment: Raw or Equipped. Knee wraps, belts and wrist wraps are allowed in the Raw division. Equipped, please check the UPA Rule Book. Weigh-ins: 60 spots available ONLY! Friday, March 13: 9am-10:30am @ Detroit Barbell(17608 Telegraph. Brownstown, MI 48174 & 6pm-7pm @ Woodhaven High School Saturday, March 14 weigh in: 7:30am-8:00am @ Woodhaven High School You MUST be weighed in by 60 minutes before the meet or you CANNOT lift, NO EXCEPTIONS! Eligibility: Open to all UPA members. Registration is $30 per card. Include your registration money with this entry form if you need to become a member--application to be filled out at the weigh-ins. Current members must present their cards at weigh-ins or they will have to buy another one. Entry Fee: $70, $60 for Teen Division $40 for each additional division. Meet Shirts are included with entry fee for FREE, S-4XL, please mark your size Entry fee MUST accompany entry form when mailed. NO REFUNDS. Deadline: The entry deadline is March 2, 2015. $30 late fee will be assessed if entry is postmarked after the above date. Records: Lifters will also be eligible to break UPA & UPA-AD National Records. Lifters will also establish/break all UPA State Records for the division they lift in. Awards: Best Lifter awards for: Men’s UPA Full Power Raw, Men’s UPA-AD Full Power Raw, Men’s UPA/UPA-AD Full Power Equipped, Women’s Full Power Raw, Women’s Full Power Equipped, Men’s Bench Only Raw, Men’s Bench Only Equipped, Women’s Bench Only Raw, Women’s Bench Only Equipped Medals will be given to 1st-3rd place in all Men’s and Women’s classes. Best Lifters are based on Schwartz formula only! Spectator Fee: $10; Children 12 and under are free. Food & Drinks will be provided to the lifters free of cost. This meet will sell out and it is first come, first serve 60 spots only! This is also a fundraiser for the Woodhaven High School wrestling team. $10 for every entry will go towards their team! Mail this page along with your entry fee to the following address: Detroit Barbell. 17608 Telegraph. Brownstown, MI 48174 Make Checks Payable to: Detroit Barbell In consideration of the acceptance of this entry thereby for myself, my heirs, executors, and administrators waive and release any and all claims and damages I may have against the U.P.A., Jeremy Thomas, Harlan Brandenburg, Detroit Barbell, their representatives, successors, and assigns for any and all injuries or bodily harm that I may suffer while competing at the 2015 UPA/UPA-AD Michigan State Powerlifting Championships. I attest and verify that I have full knowledge of the risks involved with my participation in this event, and that to the best of my knowledge I am physically fit and able to participate in this event. Signature: _____________________________________________________ Date: _______________ Parent/Guardian (if under 18): _____________________________________ Date: ________________ Print Name: ________________________________________________________________________ Address: ________________________City: _________________ State: _______ Zip Code: _______ Phone: (_______)____________________ Email: __________________________________________ Date of Birth: _________________________ Age : _____________ Gender: ____________________ Circle Event: Full Power Bench Only Ironman CrossFit Squat Only Deadlift Only Circle division below: Raw Equipped UPA UPA-AD Circle Weight Class: Men: 114, 123, 132, 148, 165, 181, 198, 220, 242, 275, 308, SHW Women: 97, 105, 114, 123, 132, 148, 165, 181, 198, SHW Circle Division(s) Entered: A $50 fee for each additional sanction/division. Sanction: UPA & UPA-AD Division: Teen 13-15, 16-17, 18-19, Junior 20-23, Open, Submaster, Master 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 8589 etc... UPA Membership: _______ Entry Fee: _$_____ Official Meet T-shirt’s Size: _______ Late Fee: after 3/2/15 __$30__ Total: _______
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