2010 - Contest Entry Form

§         Use this form if you wish to enter an Ontario Powerlifting Association sanctioned contest.

§         Send the completed form along with the appropriate fees to the contact indicated in the contest details.

àComplete all areas of the form – Please Print Legibly

à ALL ENTRY FEES ARE NON-REFUNDABLE

Name of Contest: _____________________________________________________________________________

Your Name: ___________________________________________    Phone#: _____________________________

Address: ____________________________________________________________________________________

Email : _______________________________________________________________________

Club Representing: __________________________________________________________or  Unattached

CPU Card#: ___________    Weight Class: ________ kg    Male  Female   Date of Birth: ________________

                                                                                                                                                                                  dd/mm/yyyy

Contest Category Entered: (check all that applied)

 3-Lift             Deadlift only  Bench only   Special Athlete  Intermediate     Blind            Novice

 Sub-Junior  Junior               Master I        Master II              Master III         Open

T-Shirt size: (if applicable)________________________________________

Required Information for Provincial or National Championships:

(Note if this section is not filled out, you will not be considered qualified for Championships)

Qualifying Total: __________

Date of Qualifying Total: ___/_____/_____

Where Qualifying Total was obtained:____________________________________________

Note: All qualifying totals must be within 24 months of the competition applying for

You must be registered with the O.P.A.(Ontario Powerlifting Association) or C.P.U. (Canadian Powerlifting Union) or recognized I.P.F. (International Powerlifting Federation) affiliate.  Registration cards must be shown at weigh-in.

I.P.F. Rules will be strictly enforced.  The O.P.A. and C.P.U. reserves the right to carry out drug testing at any contest under their jurisdiction.  In order to have the right to a Provincial, National or International record, it will be required of me to undergo a drug screening test before I may be declared the record holder.

Should there be an instance during competition where I am not medically able to determine emergency medical care for myself, I authorize the Ontario Powerlifting Association or Ontario Powerlifting Club officials to take such measures and arrange for such medical and hospital treatment as they may deem advisable for my health and well-being.

In consideration of your acceptance, I hereby intend to be legally bound for myself: my heirs, executors or assigns waive and release any and all rights and claims for damages I may have against the C.P.U., the O.P.A., the Directors, the Executives or their representatives and successors and/or assigns, and the sponsors of this contest for any and all injuries suffered by me at the said contest.

Signature of Competitor: ___________________________________  Date: ______________

                                                                            (Parent/Guardian if under 18)                                                                      [12/2007]