USA Powerlifting – Liberty Games Registration

Athlete Information

Athlete Name*

First Last

Date of Birth*

Gender*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Emergency Contact*

First Last

Emergency Contact Phone*

Entry Information

2019 USA Powerlifting Membership Number*

Athlete must have a current USA Powerlifting membership. Proof of membership will be required at event check in.

Division and Event*

Masters Divisions (Class)

All lifters will be competing in the Open division, but may choose to enter the appropriate Masters division as well. Lifters will lift once, but their scores will count for their Masters AND Open score.

Women's Weight Divisions*

Men's Weight Divisions*

Do you require assistance or special accommodation?

Person Assisting (if applicable)

Waiver of Liability

By checking this box and in consideration of your acceptance of my entry, I hereby for myself, my heirs, executors, administrators and assigns, waive all claims to damages which I might have against Empire State Sports Council or their Board of Directors, USA Powerlifting, event officials, volunteers and site entities for any and all injuries suffered by me at said events.

Waiver Signature*

I accept

What led you to register for The Liberty Games?*

Total

Your entry is not done until you have completed payment. Clicking 'submit' will lead you to a Paypal page to pay for your registration. There will be no refunds for athlete non attendance.

$0.00

Liberty Games

USA Powerlifting – Liberty Games Registration

2019 USA Powerlifting - Liberty Games Registration

Athlete Information

Entry Information

Waiver of Liability

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