GPC entryform2012 by 8OU78k

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									Gender

               Male
               Female
Weight class                                 Junior
               Male 52 kg Female44 kg Division:
                    56 kg       48 kg        Open
                    60 kg       52 kg        Submaster
                    67.5 kg     56 kg        13-15
                    75 kg       60 kg        16-17
                    82.5 kg     67.5 kg      18-19
                    90 kg       75 kg        40-44
                    100 kg      82.5 kg      45-49
                    110 kg      90 kg        50-54
                    125 kg      90+ kg       55-59
                    140 kg                   60-64
                    140+ kg                  65-69
Global Powerlifting Canada
Entry form 2012 GPC Nationals                                     Please click here for more information
Name:

Age:                        Birthdate:                            e-mail:

Address:

City:                                              Province/State:                                     Postal/Zip:

Phone:                                                            Country:

Gender:

                                                                                                                             Office Use Only
Weight Class:               Male:                                 Female:
                                                                                                                                       Needs GPC
Division:                                                                                                                              card
                                                                                                                                       Paid in FULL
Competition -- check one box only please:                                                                                              Cheque #
  EQUIPPED Full powerlifting $105                                 RAW Full powerlifting $105                                           Amount owing
  EQUIPPED Bench only $105                                        RAW Bench only $105
  EQUIPPED Both $125                                              RAW Both $125

GPC membership cards are $45 for all Canadian lifters DUE ANNUALLY
GPC card #:

All lifters must be in good standing with their countries GPC affiliate.

All entries including monies must be in by May 12, 2012
LATE ENTRY CHARGES -- INCLUDE $50 ADMINISTRATION FEE, NO EXCEPTIONS!
RELEASE FROM LIABILITY: In consideration of the acceptance of my entry form in this powerlifting competition, I intend to be legally bound for not only
myself, but also for my heirs, executors, and administrators. In signing this release from liability, I waive and release any and all rights or claims for
damages I may have against Global Powerlifting Canada (GPC) or the sponsors of this contest.


Signature:

Date:

Parent/guardian:
(if under 18 years of age)


PLEASE MAKE ALL CHEQUES PAYABLE TO: GPC CANADA
Please send completed form to Brian Johnston
#200-1228 Kensington Road, NW
Calgary, AB T2N 3P7
OR email to kifitness@telus.net or michellesenger@hotmail.com

								
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