COMPLETE THE FOLLOWING AND MAIL ALONG WITH YOUR ENTRY FEE ($25.00) TO BILL KUTZER, SACRAMENTO STATE UNIVERSITY, 6000 J STREET, SACRAMENTO, CA., 95819-6073
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I AGREE BY SIGNING THIS ENTRY FOR THE 2000 CALIFORNIA STATE WEIGHTLIFTING CHAMPIONSHIPS (USAW/PWA #38-00-03) THAT I WILL ABIDE BY THE RULES OF USA WEIGHTLIFTING AND THE PACIFIC WEIGHTLIFTING ASSOCIATION. I WILL ALSO NOT HOLD RESPONSIBLE THE USAW OR PWA OR THE OFFICIALS OR THE ORGANIZERS OF THIS EVENT OR SACRAMENTO STATE UNIVERSITY OF ANY INJURIES THAT MAY HAPPEN TO ME WHILE COMPETING IN, OR WHILE TRAVELING TO AND FROM, THIS EVENT.
SIGNATURE______DATE______
SIGNATURE OF PARENT IF UNDER 18 YEARS OLD______
PLEASE PRINT THE FOLLOWING VERY CLEARLY:
NAME______PHONE #(_____)______
ADDRESS______CITY______ZIP______
BODYWEIGHT CLASS______AGE______DATE OF BIRTH______
1999 USAW CARD NUMBER______
MALE OR FEMALE______USAW CLUB______