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2015 USA Powerlifting
North East Collegiate
Championships
Sanction # PA-2015-01
Feb. 14th, 2015
Scranton, Pennsylvania
Official National Championship Qualifier
Version 1.1 Nov. 17th, 2014
Format: Collegiate 3 Lift, lifters can go raw or equipped, but
no individual medals. Official qualifier for USAPL Collegiate,
Raw Nationals and Bench Press Nationals 2015
Location: University of Scranton, Bryon Recreation Center,
Scranton, Pennsylvania (GPS to 212 North Webster Avenue,
Scranton, PA) right into parking lot of Recreation Center
Recommended Hotel:
Hilton Hotel
Address: 100 Adams Ave, Scranton, PA 18503
Phone:(570) 343-3000
Group Name: Pure Powerlifting
Travel: Recommended airport Wilkes-Barre Scranton (AVP)
- $5 for shuttle to the venue / hotel
Requirements/Eligibility Requirements: Must be a
registered USAPL Member (memberships sold at weigh-ins).
Trophies: Only team awards / best lifter awards.. No
individual medals per division / weight class
Meet Director: Steven Mann
([email protected]) – (570)309-6316
Schedule:
Saturday – Feb. 14th, 2015
7:30 to 9:00 am – Weigh-in/Equipment check for the Female 43 – 63 & Male 53-83
9:30 to 1:00 pm – Commencement of lifting
1:00 to 1:30 pm – Drug-testing Protocol
12:00 to 1:30 pm – Weigh-in/Equipment check for the female 72-84+ & Male 93120+
3:00 to 6:00 pm – Commencement of lifting
6:00 to 7:00 pm – Drug-testing Protocol / Awards Ceremony
* Schedule is tentative, it can change based on turnout
Version 1.1 Nov. 17th, 2014
Name:________________________________
Age:________
Date of Birth_____/_____/_____
Address:
Street_____________________________________
City________________________________________
State_____ ZIP__________
Phone (______)______________________
E-mail_________________________
Male ________
Female _________
Raw _______ Equipped __________
Weight Class (Check One)
43
47
52
57
63
72
84
84+
Female
____
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____
____
____
____
____
____
Male
53
59
66
74
83
93
105
120
120+
____
____
____
____
____
____
____
____
____
*** Make Checks Payable to “PurePowerlifting****
Postmark Entry Deadline Jan. 23rd, 2015
Mail Entries To:
Entry Fee: $60
PurePowerlifting
LATE FEE +$25!
PO Box 495
No Refunds
Chinchilla, PA 18410
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
Version 1.1 Nov. 17th, 2014
liability I waive and release everyone connected,
including but not exclusively USA Powerlifting, Steven T.
Mann, Pure PurePowerlifting.com, the spotters, the
loaders, the facility owners, the referees and equipment
manufacturers, 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 18
years of age
Enclosed Amount: _____________
(Monies to “PurePowerlifting or Steve Mann” )
****Sorry No Refunds****
Version 1.1 Nov. 17th, 2014