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UPA Utah Strength Sports Coalition Championships
@ P.S.M Barbell
Saturday April 11, 2015
Entry Form
_____________________________________________________________________________
Last Name
First Name
Middle Initial
Address_________________________________________________________________________________________
City_____________________________________________________ State______________ Zip Code_____________
Home Phone___________________________________ Work Phone _______________________________________
E-Mail ________________________________________________________ Date of Birth_______________________
Wt. Class (Men): 114 123 132 148 165 181 198 220 242 275 308 SHW (circle one)
Wt. Class (Women): 97 105 114 123 132 148 165 181 198 Unlimited (circle one)
Division/Age Group: Open Junior (20-23) Teen (13-15) Teen (16-17) Teen (18-19)
Sub master (33-39) Masters: 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 (circle one)
□Full Meet□Bench-only□Dead lift-only□ RAW
□UPA□ UPAA (Drug Free)
Non-UPA lifters may purchase
memberships at the meet ($30 for UPA and $10 for
USSC)
Full Meet Entry Fee--$60
BENCH ONLY – DEADLIFT ONLY$ 60
Additional Divisions Entry Fee--$30
UPA card=$30, USSC card=$10
UPA TEEN CARD = $ 15
□ Cash payment enclosed
□ Check payment enclosed
□ Money order payment enclosed
ALL COMPETITORS MUST R.S.V.P. to: [email protected] ASAP with their name, address, phone
number, weight class, division/age group, and whether they’re full meet, bench-only, deadlift-only. Make checks or
money orders payable to: Heather Gibson.
Note: Each athlete MUST show his/her UPA membership card at weigh-in. If he/she cannot, then they will have to buy
one and their membership will be extended a year. USSC athletes MUST also have a USSC membership to compete in
this meet.
Waiver: In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors, and administrators waive
and release any and all rights and claims for damages I may have against the UPA, USSC, Heather Gibson, Jason
Gibson, Ed Kinsey, Mori Academy, and PSM Barbell, their representatives, successors, and assigns for any and all
injuries or bodily harm that I might suffer while competing at the UPA Utah Strength Sports Coalition Championships on
April 11, 2015.
_____________________________________
Signature of Competitor or Parent/Legal Guardian if Competitor is under 18 years of age
Mail entries to:
CELL # 1-801-920-4165 JASON
# 1-801-698-8003 ED
Heather Gibson
2957 WEST 4275 SOUTH
Roy, UT84067
TOTAL
MEET DIRECTOR:
Heather Gibson 801-920-9625
*E-mail [email protected]
EVENT LOCATION:
The Mori Academy
5385s 1950 w
Roy, UT84067
ELIGIBILITY:
Open to all UPA and USSC Registered
Athletes: Must show proof of UPA card
at weigh in. All entries in UPA
sanctioned events must have a valid UPA
Registration card. Fee is $30 per card.
UPA registration for high school $15.
Registration will be available at weighins. USSC membership is $10.
WEIGH-IN:
24-HOUR WEIGH-IN RULE APPLIES
Weigh INS:
The Mori Academy
5385s 1950 W
Roy, UT 84067
Friday April 10 th - 9-11 am, 4-6 pm
EVENT START TIME:
Saturday April 11, 10 AM
Rules Meeting: 9:00 AM
CONTEST LIFTS:
Full Power, Bench Only, Deadlift Only
AWARDS:
Amateur: 1st-3rd in each weight class
in each division.
There will be best lifter awards by the Schwartz Formula.
RULES:
United Powerlifting Association
(UPA). Check www.UPAPower.com
for information and rulebook.
UNIFORM:
Must have one piece lifting suit or
wrestling suit (Singlet).
ENTRY DEADLINE:
LIFTERS:
April 5th no later no exceptions!
25 LIFTER MAX: As soon as we hit
that number we will no longer take
applications. No exceptions!
SPONSERS: PSM BARBELL
ENOX SPORT
UTAH STRENGTH SPORTS COALITION
MORI ACADEMY
GNC
THE SHOP
THE BODY EVOLUTION