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2012 N.S. PROVINCIALS AND INVITATIONAL CHAMPIONSHIPS

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					       2012 N.S. PROVINCIALS AND INVITATIONAL CHAMPIONSHIPS
DATE: Saturday, May 26th, 2012
PLACE: Digby Elementary School
     Victoria Street, Digby N.S.

TIMES:
Weigh In: Powerlifting 7:00am, Lifting Begins at 9:00am
Bench Press 12:00 pm, Lifting Begins at 2:00 pm


* SUBJECT TO CHANGE *
ENTRY FEES: Powerlifting - $60
(circle one) Bench Press - $60
              Both Events -$90


ENTRY FEES: High School & Special Olympics Lifters Only
(circle one) Powerlifting - $40
Bench Press - $40
Both Events - $60

** ENTRY FEE INCLUDES MEET T-SHIRT !!

2012 CPU CARDS: CPU Athletes - $60
(circle one) High School Athletes - $40
Special Olympics Athletes - $40

Meet Hotel: Coastal Inn Digby
Tel: 902-245 4747
toll fee : 1 800 401 1155
Meet Prices: $79 and $89/Night
Reference Title: Powerlifting Confirmation # 56626
Offer available only till May 16th 2012

Awards: All Categories

Meet Directors: Paul Gidney: 902-245-4302

Entry Deadline: Postmarked By May 11, 2012. No late entries.

Please stay for the AGM after the meet is over. It would be greatly appreciated if you stayed after
the meet to help tear down the equiptment. We will be setting up Friday night , if you are around
please come over to help. Thank you.

Please Note : This is a CPU sanctioned event. New 2012 CPU cards are required for all lifters
and will be available at the competition if you do not already have one. The CPU follows the
anti doping rules and regulations of the WADA code. Please refer to the CPU constitution
regarding anti doping policies. (www.powerlifting.ca).
                     2012 N.S. PROVINCIALS AND INVITATIONAL CHAMPIONSHIPS

                                    (Please return this form with entry fee)



NAME______________________________________________CPU CARD#______________

ADDRESS:__________________________________________Postal Code____________

CITY: _________________________________________________________

PHONE: _______________________________

EMAIL:______________________________________

DATE OF BIRTH: ____________________________________ SEX: (Please Circle) M F

AGE CLASS (Circle One):

SUB-JUNIOR            JUNIOR        OPEN       MASTER I II III IV SPECIAL OLYMPICS

WEIGHT CLASS (Circle One):

(MEN)       53Kg       59Kg 66Kg 74Kg 83Kg 93Kg 105Kg 120 Kg                                      120 +Kg

(WOMEN) 43Kg 47Kg 52Kg 57Kg 63Kg 72Kg 84Kg,                                            84+ kg

Total Enclosed: _________________


WAIVER FORM
 In consideration of accepting this entry, I hereby for myself, heirs, executors and administrators, waive and release
any and all rights and claims for damages I may have against: the International Powerlifting Federation, the
Canadian Powerlifting Union, the N.S. Powerlifting Association and Executive, The Culloden Powerlifting
Club, the meet/contest site sponsor and it's employees, all organizers, volunteers and sponsors of this contest, from
any and all actions, causes of actions, claims and demands which may arise in consequence of my participation in
this contest. I realize that Powerlifting is a “high risk” sport and that I could be injured. I certify that I am in good
physical health and that I have no serious health problems and that I assume full responsibility for such conditions.
I accept that I am fully responsible for my wellbeing and safety in the warm up room, on the lifting platform and
while I am competing at this event. I am also aware that I am responsible for the actions of any coach and entourage
that attend this contest in my support. I also certify by my signature that I have read this waiver and fully
understand and accept its terms. I do hereby verify my acceptance of these terms by my signature below.

SIGNATURE: _________________________________________________________
PARENT OR GUARDIAN (if under 18)_______________________________________
DATE: _____________________

                                          Mail Payments & Entry Forms to:
                                       Paul Gidney, RR#3 Digby N.S., B0V1A0

				
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