Entry Form
Nevada Teenage Weightlifting Championships
June 2, 2007

I agree by signing this Entry Form for the 2007 Nevada Teenage Weightlifting Championships that I will abide by the rules of USA Weightlifting. I will not hold responsible the USAW, American Iron Gym, Nevada Barbell Club, the officials or organizers of this competition for any injuries that may happen to me while competing in or traveling to and from this event.

Signature______________________________________Date__________

Signature of parent or guardian if under 18

Signature______________________________________Date__________

PLEASE PRINT CLEARLY

Name_______________________________________________________
Address____________________________________________________
City________________________________State______Zip_________
Phone(______)________________USAW#_____________________
Weight-Class_______kg. Age______Date of Birth______________
Male_____Female_____School/Team____________________________
T-Shirt Size_______(S,M,L,XL,XXL,XXXL)
Additional shirts $10.00
Sizes____________________________(include payment with entry)
Entry Fee: $10.00 - postmarked no later than
May 22, 2007, to receive a t-shirt.

Mail Entry and Fee to:

Dick Halminiak
P.O. Box 18725
Reno, NV 89511