Spokane’s Turkey Stuffing Strength Wars Push Pull Date & time: Saturday, November 8th 2014, @ 10:30 AM Location: CrossFit Spokane, 116 E Augusta, Spokane Wa 99207 Sanctioned by: Triple X PowerLifting Eligibility: Any Male or female age 13 years or older. No membership card needed. Divisions: All age groups for – Open Weight Classes: Men: 114, 123, 132, 148, 165, 181, 198, 220, 242, 275, 308, & 308+ Women: 97, 105, 114, 123, 132, 148, 165, 181, 198, 198+ Gear Rules: www.swolerx.com/events/plrules Weigh-In Schedule: Weigh-in & equipment Check: 5pm till 9pm on Friday Saturday: 9:00am to 10:00am Lifting Schedule: Competitor Meeting:-------------------------------Saturday @ 10:00am Lifting Begins:---------------------------------------Saturday @ 10:30am Awards: Cash prizes for best lifters by body weight Entry Fee: $40 per lifter Payment: Make Checks or money over payable to: CrossFit Spokane Send entry form and payment to: CrossFit Spokane, 116 E Augusta Suite A, Spokane WA 99207 Questions: SwoleRx@gmail.com Website: You may go to www.SwoleRx.com for more information and rules. Spokane’s Turkey Stuffing Strength Wars Name: _____________________________________ Age on Nov 8th:__________________ Birth date:_____________ Address:____________________________________________ City:_________________________________________ Sate:_________________ Zip:______________ Phone Number: (_______)___________________________________ Email:____________________________________________________________________________________________ Please circle the category you will compete in: Raw Single Ply Multi Ply Circle the weight class you are entering Men’s Weight Classes: 114 Women’s Weight Classes: 123 132 148 165 181 198 220 242 275 308 308+ 97 105 114 123 148 165 181 198 198+ Circle the Division you are entering Push / Pull (Open) Bench Only (Open) DeadLift Only (Open) Opening Lifts (These numbers can be changed) Bench:____________________ Entry Fee: DeadLift:____________________ $40 for one event and division. Entries must be postmarked by Nov 1st, 2014. NO ENTRIES ACCEPTED ON DAY OF CONTEST. Entries postmarked after Nov 1st must pay $20 late fee. Meet T-Shirts: Free shirt with entry fee. A limited number of Meet T-Shirts will also be available to purchase at the meet. Circle T-Shirt Size: S M L XL 2XL 3XL 4XL Entry Fee $40 with T-Shirt: $________________________ Late Fee $20 if mailed after Nov 1st: $________________________ Total Due: $________________________ Please mail your entry form waiver and payment to: CrossFit Spokane, 116 E Augusta Suite A, Spokane WA 99207 RELEASE OF LIABLITY – READ BEFORE SIGNING and return with entry form and fee In consideration of being allowed to participate in any way in the Spokane’s Turkey Stuffing Strength Wars by Triple X PowerLifting & SwoleRx. Its related events and activities. I,_______________________________________, the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury form the actives involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or other, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazed during my presence or participation, I will remove myself from participation and bring such to the attention of the Triple X PowerLifting officials immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Meet Director/promoter, CrossFit Spokane, Triple X PowerLifting and their officers, official, agents and/or employees, other participants, sponsoring agencies, sponsor, advertisers, and, if applicable, owners and lessors of premises used for the activity (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABLITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABITY AND ASSUMTION OF LIABLITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERM, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREEKY AND VOLUNTARTLY WITHOUT ANT INDUCEMENT. x_____________________________ Participants Signature Age:_______ Date Signed:_______________ FOR PARENTS/ GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRAION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless Releasees from any and all liabilities incident to my mirror child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. x_______________________________ PARENT/GUARDIAN’S SIGNATURE Date Signed___________ EMERG. PHONE #: _____________________ Please mail your entry form waiver and payment to: CrossFit Spokane, 116 E Augusta Suite A, Spokane WA 99207