BLACKBERRY BARBELL Presents the USAPL N.Y.S BENCH PRESS & DEADLIFT CHAMPIONSHIPS
SATURDAY JANUARY 8, 2005
This is a sanctioned USA Powerlifting event. You must be drug free according to usapl standards (minimum 3 years). Urinalysis drug testing will be done at this meet. USAPL state records can be set here. Check the web site for current records at http://www.geocities.com/bruceswan500/index.html 60 Lifters maximum will be allowed. First come first serve. Get your apps in early.
You must be a REGISTERED Usapl member. Membership Cards will be available at meet.
WHERE
Brewster Health & fitness 1620 Rt 22 Towne Centre Brewster, NY 10509
Located @ intersection of Rt 312 & Rt 22 (in the McDonald's Shopping Center) Phone# 914-278-8801
SCHEDULE
Sat, Jan 8: 9:30am Weigh in/Equipment check 10:45am Rules clinic` 11:00am Lifting Begins
EQUIPMENT
Must conform to usapl rules and specifications. See website for details. Lifting Singlet is mandatory. Single Ply-Bench Shirts, Deadlift Suits, Erector Shirts, wrist wraps, belt, etc. NO DENIM SHIRTS.
AWARDS
1st thru 3rd Place in all Divisions
Best Lifter Awards
Open Bench Press Overall
Open Deadlift Overall
ENTRY FEE
$55 First Div. $35 Additional Div. $40 Team Entry Fee
Entry to Public: $5.00 Adults, children under 12 Free
Make checks payable to and mail to:
Bruce Swanson * 15 Palisades Rd.* Patterson, NY 12563
REGISTRATION DEADLINE
DECEMBER 24, 2004
A $25.00 late fee MUST BE INCLUDED with all applications postmarked after the deadline.
NO APPLICATIONS WILL BE ACCEPTED AFTER DECEMBER 24, 2004
For additional info contact meet directors:
Bruce Swanson (845)279-2346 David Corsi (845)279-3817
BLACKBERRY BARBELL NYS USAPL Bench Press and Deadlift ENTRY FORM
Name________________________________________________ Age_____________
Address______________________________________________
City_______________________________ State____________________Zip_________
Phone________________ Wt Class___________________________
Team_________________________________EMail________________________________
Meet T-shirts are available for $15 each. Include t-shirt fee with entry fee. Circle t-shirt size ( S M L XL XXL)
Events: Division (Circle choices: Bench only, Deadlift only, or Ironman)
Bench Only Deadlift Only Ironman (Benchpress & Deadlift)
DIVISIONS & WEIGHT CLASSES CIRCLE DIVISION & WEIGHT CLASS
Men's Open, Master, Submaster(35-39), Special Olymp., Teen, Raw, Novice
114 123 132 148 165 181 198 220 242 275 319 SHW
Women's Open, Master, Submaster(35-39), Special Olymp., Teen, Raw, Novice
97 104 114 123 132 148 165 181 198+
ACKNOWLEDGEMENT, WAIVER & RELEASE FORM LIABILITY-ALL ATHLETES MUST READ THIS RELEASE CAREFULLY BEFORE SIGNING. I hereby assume the risks of participation in this event. I certify that I am physically fit, that I have trained sufficiently for this event, and have not been advised otherwise by a qualified medical person. In return for permission to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin successors and assigns as follows: I waive release, discharge, and agree not to sue, from any all liability for my death, disability personal injury, property damage, Property theft or action of any kind which may hereafter accrue to me as a result of my participation in this event. The following persons or entities: Bruce Swanson, Brewster Health & Fitness, David Corsi, Usa Powerlifting, Event Sponsors, directors, staff or volunteers, any and all cities, counties, districts and/or states in which this event may be staged or in which segments of this and the officers, directors, employees, representatives, agents and volunteers. I also indemnify and hold harmless the persons or entities mentioned in the paragraph from any and all liabilities or claims made by other individuals or entities as a result of my actions during this event. I understand that this event will be conducted. I agree to comply with all applicable state laws, and event instructions. I consent to receive medical treatment if it is necessary during the event. I certify that I am (18) eighteen years of age or older, that I have read this document and that I understand its content. If I am under 18 years of age, I certify that my parent/guardian has read and completed the waiver. 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. I understand this release and agree to its terms with my signature. Participation is deemed ratification of a forged signature.
Signed______________________________ Date________________
Drug Test Waiver
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.
Signature of Contestant Date
Signature of parent or legal guardian if contestant is under 18 years of age Date
DIRECTIONS TO:
Brewster Health & Fitness
1620 Route 22, Towne Center
Brewster, NY 10509
Ph# 845-278-8801
From Upstate New York:
Take I 84 East to Exit 19( Route 312, Brewster New York)
Make LEFT at end of ramp.
Follow Route 312 to the end. This will be intersection of Route 312 and Route 22.
Go Straight into the McDonalds Restaurant Plaza in front of you.
The gym is located on the 2nd floor of the plaza all the way to the left.
From Ct and points East:
Take I 84 West to the Route 22 North exit. You will see this exit about 3-5 minutes after you go over the New York State Border.
Take Route 22 North(approx 5 minutes), at the Third traffic light there will be a McDonald's on your right. Follow directions above
From New York City/NJ and points South:
Take I 684 North to the last exit. This is Route 22 North toward Pawling. Take Route 22 North(approx 5 minutes), at the Third traffic light there will be a McDonald's on your right. Follow directions above
Motels/Hotels:
Bel-Aire Motel (845) 279-3350 Route 22, Brewster, NYHilton- Mill Plain Road, Danbury, CT
