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View Full Version : Date change for apf nys championships! Changed to april 16th!!



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: