DATE: Saturday, January 21st, 2012
PLACE: Medicine Hat Cultural Center
299 College Dr SE, Medicine Hat AB
TIMES: Weigh In: 9:00am-10:30am (Venue opens at 8:30)
Lifting Begins: 11:00am
FEE: Powerlifting - $45
Bench Press - $25
Both - $55
ENTRY DEADLINE: January 10th, 2012
Entry amount shall be limited to 20 lifters for 3-lift
AWARDS: Both Male and Female Best Lifter awards.
T-shirts for participation
VIKING OPEN 2012
NAME: ______
ADDRESS: ______
CITY: ______POSTAL CODE: ______
PHONE: ______EMAIL:______
DATE OF BIRTH: ______SEX: (Please Circle) MALE FEMALE
AGE CLASS(Circle One): T-SHIRT SIZE(Circle One):
SUB-JUNIOR JUNIOR OPEN MASTER I II III IV S M L XL 2XL 3XL
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
EVENT(Circle One): $45 Powerlifting $55 Both Events
$25 Bench Only
DIVISION(Circle One): Standard Classic
EXPERIENCE(Circle One):
1. I am a first time competitor in CPU/APU powerlifting or I have not competed in the last two years
2. I am a regular competitor in the CPU/APU powerlifting
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 Alberta Powerlifting Union and Executive, the meet/contest site sponsor and it's employees, Temple Fitness, 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 well being 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. In the event I am disqualified from this contest by means of rule infractions or due to my conduct I will not be eligible for reimbursement of contest entry fees. 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(Payable to Kain Lyon) & Entry Forms to: Kain Lyon
926 Parker Ave NW
Medicine Hat, AB, T1A 6W6
Inquiries: or 403-502-7409