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2012 APF NEW YORK STATE
FULL POWER CHAMPIONSHIPS
March 24TH, 2012

SPONSORED BY: SHAWNA MENDELSON & TEAM BLUE COLLAR BARBELL

EVENT LOCATION: ALL NATURAL GYM
163 SOUTH 11TH STREET
LINDENHURST, NY
631-957-7373

ELIGIBILITY: Open to all APF registered athletes.

WEIGH-IN: ALL NATURAL GYM
24 hour weigh in rule will apply.

Friday - March 23rd 11:00am - 4:00 pm
Saturday March 24th 9:00 am – 10:00am

Meet will be Raw and Equipped!

COMPETITION: Mandatory rules briefing Saturday at 10:30 am

LIFTING SCHEDULE: Saturday March 24th. Meet will Start at 11am Sharp!

UNIFORM: Mandatory - Must have one piece lifting suit or wrestling singlet.
APF Rules apply.

CONTEST LIFTS: Squat - Bench Press – Deadlift and/or Bench Press Only

ENTRY FEE: $100 for the full meet, $80 for Push/Pull, $60.00 Bench only!
MARCH 19TH, 2012. $20.00 late fee for any entries allowed in after the deadline.

AWARDS: 1-3rd place and Best Lifter in each category based on content of entries.

2012 APF NEW YORK STATE RECORD BREAKER
FULL POWER CHAMPIONSHIPS
March 24th 2012

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: □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 □ Push/Pull (must lift in both)

Raw , Single Ply, Multiply Please circle!

Fees & Payment: Late fee after 3/19/2012 $20 $___________

AAPF# _________ Exp. Date __________

Entry fee Powerlifting $100 $___________

Entry Fee Push/ Pull $80 $___________

Entry Fee Bench Only $ 60 $___________

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 2012 APF NY State Championships, MARCH 24TH, 2012.SIGN HERE X

RETURN ENTRY FORMS TO: MAKE CHECKS PAYABLE TO SHAWNA MENDELSON
ALL NATURAL GYM 163 SOUTH 11TH STREET LINDENHURST, NY (631) 957-7373
Thenewgym@gmail.com