shawnamendelson
01-09-2011, 01:09 PM
Come check out our event! Going to be a great day!!! Hope to see you all soon!
2011 APF
FULL POWER CHAMPIONSHIPS
April 9th, 2011
ALL NATURAL GYM 163 SOUTH 11TH STREET LINDENHURST, NY
Entry Form
Competitor:
Last Name First Name MI
Address _________________________________________________________________________
City _________________________________ State ____________ Zip Code _________________
Home Phone _______________________ Work Phone ______________________ Age ________
e-mail ___________________________________________ Date of Birth _____________________
Division Entered: PLEASE CIRCLE : RAW EQUIPMENT
□Open □Junior 20-23 □Teen13-15 □16-17 □18-19 □Submaster 33-39
□Masters 40-44 □45-49 □50-54 □55-59 □60-64 □65-69 □70-74 □75-79 □80-84
□ Police/Fire/Military
Class Entered Men: 114 123 132 148 165 181 198 220 242 275 308 SHW
Class Entered Women: 97 105 114 123 132 148 165 181 198 Unl
Men □ Women□ Wt Class____________ □Powerlifting □Bench Press □Both (must lift in both)
Fees & Payment:
Entry fee Powerlifting $75 $___________
Entry Fee Bench $50 $___________
Late fee after 3/30/2011 $50 $___________
APF# _________ Exp. Date ________
TOTAL DUE $___________
Paid: □Cash □ Money Order/Cashiers Check
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 APF, AAPF, Shawna Mendelson, ALL NATURAL GYM, their representatives, successors, and assigns for any and all injuries or bodily harm that I might suffer while competing at the 2010 APF NY State Championships, APRIL 9TH, 2011.
SIGN HERE X__________________________
RETURN ENTRY FORMS TO: MAKE CHECKS PAYABLE TO SHAWNA MENDELSON
ALL NATURAL GYM 163 SOUTH 11TH STREET LINDENHURST, NY
SMENDELSON2010@HOTMAIL.COM Phone 516 993-6378
2011 APF
FULL POWER CHAMPIONSHIPS
April 9th, 2011
ALL NATURAL GYM 163 SOUTH 11TH STREET LINDENHURST, NY
Entry Form
Competitor:
Last Name First Name MI
Address _________________________________________________________________________
City _________________________________ State ____________ Zip Code _________________
Home Phone _______________________ Work Phone ______________________ Age ________
e-mail ___________________________________________ Date of Birth _____________________
Division Entered: PLEASE CIRCLE : RAW EQUIPMENT
□Open □Junior 20-23 □Teen13-15 □16-17 □18-19 □Submaster 33-39
□Masters 40-44 □45-49 □50-54 □55-59 □60-64 □65-69 □70-74 □75-79 □80-84
□ Police/Fire/Military
Class Entered Men: 114 123 132 148 165 181 198 220 242 275 308 SHW
Class Entered Women: 97 105 114 123 132 148 165 181 198 Unl
Men □ Women□ Wt Class____________ □Powerlifting □Bench Press □Both (must lift in both)
Fees & Payment:
Entry fee Powerlifting $75 $___________
Entry Fee Bench $50 $___________
Late fee after 3/30/2011 $50 $___________
APF# _________ Exp. Date ________
TOTAL DUE $___________
Paid: □Cash □ Money Order/Cashiers Check
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 APF, AAPF, Shawna Mendelson, ALL NATURAL GYM, their representatives, successors, and assigns for any and all injuries or bodily harm that I might suffer while competing at the 2010 APF NY State Championships, APRIL 9TH, 2011.
SIGN HERE X__________________________
RETURN ENTRY FORMS TO: MAKE CHECKS PAYABLE TO SHAWNA MENDELSON
ALL NATURAL GYM 163 SOUTH 11TH STREET LINDENHURST, NY
SMENDELSON2010@HOTMAIL.COM Phone 516 993-6378