Team Savannah Qualifier
Anderson / Cohen Weightlifting Center
November 5, 2011
For more info:Email: cheetahmik@aol.com
Or call 912-351-3500
Awards will be given for 1st - 3rd place in total for each
weight division in school age, junior, senior and master. Best lifter
awards.
Saturday,
November 5, 2011| Session | Weight Class | Weigh-In | Lift |
| 1 | All
Males 13 & Under And All Women |
8:00am | 10:00am |
| 2 | All
Males 14 & Up |
10:00pm | 12:00pm |
Entry Fee:$
15 Make checks payable to Team Savannah Booster Club.Mail Entry Form below to Team Savannah, PO Box 16507, Savannah, GA 31406.
Entry Form Below:
Team Savannah Qualifier
Saturday, November 5, 2011
OFFICIAL ENTRY FORM
WEIGHT CLASS: ________________KG (You can only enter one)
NAME__________________________________________________ USAW #_______________
(Last)
(First)
(Middle)
Athlete’s Signature:_______________________________________________ Date:______________
e-mail:____________________________________________________________________________
ADDRESS__________________________________________________________________________
CITY_____________________________________ STATE_________ ZIP________________
PHONE (_______)__________ E-MAIL __________________________ AGE_______ DOB_________
COACH: __________________________________________________________________________
WILL THIS BE YOUR COACH AT THIS MEET? __YES __ NO (If no, then
whom?)____________
Coach’s USAW #___________
(COACH MUST BE A CURRENT USA
WEIGHTLIFTING MEMBER TO ACCESS THE WARM-UP ROOM)
USA WEIGHTLIFTING CLUB AFFILIATION__________________________________ CLUB #:____________
__ MALE __ FEMALE *U S. CITIZEN: __ YES __ NO
______School-age _______Junior ______Senior _______Master
*Athletes must be U.S. Citizens to compete*
UNDER AGE ATHLETES
ATHLETES UNDER 18 YEARS OF AGE MUST HAVE THE FOLLOWING SECTION COMPLETED BY A PARENT OR GUARDIAN
I have explained to my son/daughter the aforementioned releases and conditions and their ramifications and I further consent to his/her registration for this USA Weightlifting activity under the above stipulated conditions.
SIGNATURE_____________________________________________________________ DATE__________________
PRINTED NAME: _______________________________________________________________ (Parent or Guardian)
IF YOU ARE UNDER 18 YEARS AND YOU HAVE FAILED TO HAVE YOUR PARENT OR GUARDIAN SIGN THIS RELEASE, YOU WILL NOT BE PERMITTED TO LIFT or COMPETE.
FOR USA WEIGHTLIFTING MEMBERSHIP APPLICATION, SEE YOUR COACH,OR VISIT WWW.USAWEIGHTLIFTING.ORG