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Gold's Gym Just Pull It!

Deadlift Competition January 26, 2:00pm Gold's Gym South Spokane Registration Form (please print) Name:________________________________________________________________________ Address:______________________________________________________________________ City________________________ State:___________ Zip Code__________________________ E-Mail Address_________________________________________________________________ Phone ________________________________________________________________________ Date of Birth_________ Male_____ Female______ I am lifting: Division _________ Weight Class_________

T-Shirt Size/Quantity: S______ M______ L______ XL_____ XXL_____ XXXL____ January 11th Early Registration: $20 Jan 12th-26th Late Registration: $35 (No shirt included)

Extra Shirts: $15

Amount Enclosed (entry fee + additional shirts) $_____________________


Checks and cash accepted for payment. Please make checks out to: Golds Gym Spokane.

Turn in registrations in person at: Golds Gym 2921 E 57th Ave Spokane, WA 99223

Or mail registrations to: (Mail in deadline: January 20th) Danna Snow PO Box 30046 Spokane, WA 99223

RELEASE FROM LIABILITY Important: Read this release carefully. When you sign it, you will be giving up important legal rights. In consideration of the acceptance of my entry blank in this Powerlifting competition I intend to be legally bound, for not only myself but also for my heirs, executors, and my administrators. In signing this release from liability I waive and release everyone connected with this competition which includes the meet directors, Danna Snow, Gold's Gym South, and sponsors of the meet, meet staff and volunteers from any and all liability which may arise from this competition. I agree to pay any attorney fees and litigation expenses incurred by any persons, real or corporate, whom I may sue in an effort to challenge this release from liability form. I understand that my agreement to pay attorney fees and litigation expenses is the sine qua non for the acceptance of my entry in this contest. If any provision of this Release from Liability shall be deemed by a court of competent jurisdiction to be invalid, the remainder of this Release from Liability shall remain in full force and effect. I also certify with signature that this release/agreement cannot be modified orally. Print Name___________________________________ Signature_____________________________________ Date ___/___/___ Signature of parent or guardian if the applicant is under 18 years of age. ____________________________________________ Date ___/___/___

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