shawnamendelson
02-13-2011, 10:12 AM
2011 APF FULL POWER CHAMPIONSHIPS
ALL NATURAL GYM 163 SOUTH 11TH STREET LINDENHURST, NY
April 16th, 2010
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: Late fee after 3/30/2011 $50 $___________
APF# _________ Exp. Date __________ Entry fee Powerlifting $75 $___________
Entry Fee Bench $50 $___________
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 16TH, 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
:clap:
ALL NATURAL GYM 163 SOUTH 11TH STREET LINDENHURST, NY
April 16th, 2010
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: Late fee after 3/30/2011 $50 $___________
APF# _________ Exp. Date __________ Entry fee Powerlifting $75 $___________
Entry Fee Bench $50 $___________
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 16TH, 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
:clap: