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since .09

                                          Flora High School & The Gym Present
The 2009 NASA Tri-State Natural Regional Powerlifting (Equipped and Unequipped), Bench Press, Power Sports & Push/Pull Championships
 

DATE: July 25, 2009

PLACE: The Gym
112 W. North Ave., Flora, IL., 62839 (618) 662-3413 lesmitty@bspeedy.com
 

TIME: Meet Starts at 9 a.m.
WEIGH-INS: July 24, from 6 -8 p.m., 112 W. North Ave., Flora, IL., (618) 662-3413
Saturday, July 25, from 7 a.m. until 8 a.m.
 

WEIGHT CLASSES: 114, 123, 132, 148, 165, 181, 198, 220, 242, 275,
308, SHW. Women Include 97 and 105
 

All Current NASA Divisions Offered in all meets

TEAM AWARDS: Maximum of ten (10) lifters per team.
BENCH PRESSERS WILL LIFT WITH THE FULL MEET

ENTRY FEE: July 11, 2009, or before, $45 1st Division, $35 Each Additional Division in this meet
AWARDS will be based on
when paidpaid entry to meet is received
After July 11, 2009 $55 1st Division, $45 Each Additional Division.
 

MOTELS: Best Western, Lorson Inn (618) 662-3054,
The Ranch Motel (618) 662-2181 or The Flora Motel (618) 662-2153
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Check written to: FLORA HIGH SCHOOL & Return this portion to The Gym,
112 W. North Ave., Flora, Illinois, 62839 (All Proceeds go to Flora High School)

Please enter me in the 2009 NASA Tri-State Natural Regional Powerlifting, Bench Press and/or Power Sport Championships. I, (we), agree to hold harmless, Flora High School, Unit #35, Lindell E. Smith, Mable F. Smith, The Gym, Natural Athlete Strength Association, (a.k.a NASA) and all staff members and officers from all liability for injuries that may be suffered at this meet, or as a result of attending or leaving this meet. I, (we) understand that weightlifting is a rigorous sport and certify that I am in condition to compete. I also certify that I am steroid free and willing to submit to any form of testing to prove my steroid free status.
 

Lifter Name: PLEASE PRINT: ____________________________________________________
Lifter's Signature________________________________________________________AGE____
Parent's Signature (If under 18)____________________________________________________
Telephone_(______)__________________ Address_____________________________________
City _______________________________________State______________ZIP______________
WEIGHT CLASS__________ DIVISION(S) ENTERED_______________________________
TEAM REPRESENTED__________________________________________________________
Do Not Enter Unless You Are Steroid Free