WEIGHTLIFTING / 2017 CENTRAL ENGLAND MASTERS OPEN WEIGHTLIFTING CHAMPIONSHIP
MSC Performance,
57 Clement Street, Birmingham, B1 2SW
Saturday, 03 June 2017
Weigh-In 9 am – 10 am. Start 11 am
Please complete this form fully and in BLOCK CAPITALS Asterisks denote mandatory fields.
Name*Address*
: / Post Code*
Date of Birth* / / / / Gender*
Contact Phone No. / E-mail*
BWL Division / BWL Membership No.
Central England Masters Open Weightlifting Championships
Body weight category - Please circle (or shade) the correct value *
Men / Women
56 / 62 / 69 / 77 / 85 / 94 / 105 / +105 / 48 / 53 / 58 / 63 / 69 / 75 / 90 / +90
Total Achieved
Age at 31st December* / Age Group*
Age Groups / M35, M40, M45, M50, M55, M60, M65, M70, M75, M80
and W35, W40, W45, W50, W55, W60, W65, W70
I realise I may be tested by the UKADA at the championships and agree to comply with the instructions of the UKADA and BWL Officials. I will not leave the venue until given permission to do so by the relevant UKADA officials or any Designated Authority..
· The closing date for entries is the 10 May 2017
· Proof of BWL Membership must be presented at the Weigh-In for the duration of the competition.
· In submitting this entry form you must pay the entry fee of £21.
Payment can be made:(1) By cheque with your entry form. Cheque made payable to “Birmingham Weight Lifting”.
(2) Paid direct into our bank account: Birmingham Weight Lifting Sort Code 010832
Account Number 60269405.
Please mark Bank Reference with: CE Masters
Mail cheques and/or entry forms to - Steve Cannon, 18 Doley Close, Gnosall, Staffordshire, ST20 0HT
Tel: 0780 143 5003 Email:
I agree to be bound by the rules and regulations of IWF and IWF Masters and declare that I am physically fit to undertake the sport of weightlifting and have no knowledge of any medical condition which will make weightlifting contra-indicated to my well being.
Signed ______Date ______
Data Protection Act 1984: Information supplied on this form may be held on computer.