Entry Form

Push-Pull Meet 10.5.13

Name________________________________________________________________ Street Address_____________________________________________________ City_____________________________ State__________ Phone___________________________ Email______________________________ DOB______________Age_______

Lift: Bench ___ Deadlift ___ Push-Pull ___ Equipment: Raw __ Single-PlY __ Mutli-ply __ Division: Men___ Women___ Teen ___ Weight Class: (circle) 132 148 165 181 198 220 242 275 308 SHW $25 single lift / $40 push-pull Paid: Cash Check
WAIVER: In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors, and administrators waive and release any and all rights and claims for damages I may have against Bend Barbell, and their representatives, successors, and assigns for any and all injuries or bodily harm that I might suffer while competing at Push Pull event on October 5th , 2013 Signature Date

**Weigh ins will be held from 3:00-4:00PM on Friday the 4 th as well as 7:30-8:00 on Saturday the 5th

Send entry form to 2625 NE Butler Market Rd, Space F, Bend, OR 97701 For more information email: bendbarbell@gmail.com checks to be made out to Bend Barbell

NO ENTRIES WILL BE ACCEPTED PAST SEPTEMBER 20TH!