Please print this entry form or copy then print with a fine/ extra fine point permanent marker, check a class and mail this form along with the $80 money order(if postmarked by 3-26-12) or $100 money |
2012 JAY CUTLER DESERT CLASSIC ENTRY FORM
www.mauivegas.com
OPEN MEN: Bantam Weight (up to 143.25#) Light Weight (143.5#--154.25#) Middle Weight (154.5#--176.25#)
Light Heavy Weight (176.5# - 198.25#) Heavy Weight (198. 5# - 225.25#) Super Heavy Weight (over 225.25#)
NOVICE MEN: Light Weight (up to including 165 1/4) Middle weight (over 165 1/4 up to and incl. 187 ¼) Heavy Weight (over 187 ¼)
OPEN WOMEN: Bodybuilding one class
MASTERS (40-49 YEARS) MEN: Classes dependent upon number of pre-entries GRAND MASTERS (50 & OVER) MEN: One class
TEEN MEN: Age classes dependent upon number of pre-entries
*FITNESS WOMEN: Classes dependent upon number of pre-entries
*FIGURE WOMEN: Classes dependent upon number of pre-entries *MASTERS (OVER 35) FIGURE WOMEN: One Class
MEN’S PHYSIQUE ¨ Three Classes WOMEN’S PHYSIQUE ¨ Classes dependent upon number of entries
TEEN MEN’S PHYSIQUE One Class MASTERS MEN’S PHYSIQUE (over 35) One Class
BIKINI : Classes dependent on number of athletes
MEN’S WEELCHAIR One Class
I’ve enclosed: $80 Early Entry Fee if mailed before 3-26-12 (+ $50 if crossing over) or $100 Regular Entry Fee if mailed after 3-26-12
MONEY ORDERS ONLY!
NAME:______________________________________________ AGE:_________ TELEPHONE:(H)(____________)__________________________
ADDRESS:______________________________________ CITY:___________________________ STATE:_______________ Zip:______________
HEIGHT:__________ E-MAIL ADDRESS (REQUIRED FOR ENTRY CONFIRMATION):________________________________________________
I TRAIN AT:______________________________________________ IN CITY OF:_____________________________________________________
OWNER’S NAME:_________________________________________ GYM PHONE:(__________)________________________________________
GYM ADDRESS:_____________________________________ CITY:__________________________ STATE:_____________ Zip:______________
BEST/MOST RECENT ACCOMPLISHMENT:___________________________________________________________________________________
RELEASE WAIVER OF ALL CLAIMS (PLEASE READ CAREFULLY): In consideration of your acceptance of my non-refundable, subject to a $30 returned check (NSF, Stop Payment or other) fee, entry to participate in this event, I hereby for myself, my heirs and others covenant not to sue, forever discharge, waive and release all rights and claims for damages I may have against Powerhouse Gym, Redford Theater, National Physique Committee of the USA, Michigan District of the NPC, Sponsors, Vendors or any of their agents, representatives, successors and assignees, for any and all injuries or claims of any type which may be suffered by me at this or any event which is associated with it or while traveling to or from the event/s. I understand that I will be personally and financially responsible for all curtains, linens, towels, carpet, furniture or other item/s damaged as a result of my use of tanning products or oil or of any act of negligence or aggression. Further, I agree to financially reimburse in full any person/s and/or entity for any and all such damage upon notice of such charge. I also hereby grant the NPC and any approved video or entertainment organization, and all of their agents, successors, licensees and assignees, the right to photograph or otherwise reproduce, whether by film, tape, or still photography or otherwise, my voice, and/or appearance in any and all media, including without limitation photos, TV, cable TV, print or electronic media, including with respect also to any merchandising, advertising and/or publicity, and the right to use my name and information about me in connection with any of the foregoing. The rights granted by me hereunder are granted for the entire universe and shall endure in perpetuity and no further compensat
Email us at: jeruspro@hotmail.com
Visit us at: www.jaycutlerdesertclassic.com |
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