MEXICAN POWERLIFTING FEDERATION
2004 WORLD
POWERLIFTING CHAMPIONSHIPS
Venue: YMCA, Chihuahua, México
1º mayo and 14 street, col. Santa Rita
Promoter: Victor Ismael Gómez Cortes
Dates: 26th & 27th November
- ENTRY FORM -
Last Name First
Name
Organization
No
County
Postal
Address
Post Code
Phone No.
Date of
Birth
Age
Nationality
Sex-Male/Female
Bodyweight
Category (Circle appropriate category)
_______________________________________________________________
Men’s 56 60
67.5 75 82.5
90 100 110
125 140 140+
_______________________________________________________________
Women’s 44 48
52 56 60
67.5 75 82.5
90 90+
________________________________________________________________
You
will be allowed to move up only one weight class that your have entered
if over weight
Age Category (Circle appropriate category)
Teenager 10/13 – 14/15 – 16/17 – 18/19 – Junior
U23 – Open – M40+ - M45+ - M50+ - M55+ - M60+ - M65+
I hereby agree to enter this competition on the
following terms:
1.
I take part entirely at my
own risk and that there shall be NO
liability whatsoever on the part of the Promoter, World Powerlifting
Federation, Mexican Powerlifting Organization, its officers, employees or
agents for any loss, damage or injury suffered by me, howsoever caused.
2.
That I know of no reason why
I should not take part on the grounds of ill health.
3.
I enclose my $ 700 pesos
entry fee payable to the Mexican Powerlifting Organization, which is
non-refundable.
4.
All entry forms and fees to
be sent to be sent to the Mexican Powerlifting Organization, to be received by NO LATER than 26th
October 2004.
Signature______________________________________________________
Date_________________________
I am the Parent/Guardian
of______________________________________________________________________
Named above who is under 18 years of age and I
confirm acceptance of the above terms on his/her behalf.
Signature______________________________________________________Date___________________________
MEXICAN
POWERLIFTING FEDERATION
2004 WORLD
BENCH PRESS CHAMPIONSHIPS
Venue: YMCA, Chihuahua, México
1º mayo and 14 street, col. Santa Rita
Promoter: Victor Ismael Gómez Cortes
Dates:
28th November
- ENTRY FORM -
Last Name
First Name
Organization
No
County
Postal
Address
Post Code
Phone No.
Date of
Birth
Age
Nationality
Sex-Male/Female
Bodyweight
Category (Circle appropriate category)
_______________________________________________________________
Men’s 56 60
67.5 75 82.5
90 100 110
125 140 140+
_______________________________________________________________
Women’s 44 48
52 56
60 67.5 75
82.5 90 90+
________________________________________________________________
You
will be allowed to move up only one weight class that your have entered
if over weight
Age Category (Circle appropriate category)
Teenager 10/13 – 14/15 – 16/17 – 18/19 – Junior
U23 – Open – M40+ - M45+ - M50+ - M55+ - M60+ - M65+
I hereby agree to enter this competition on the
following terms:
5.
I take part entirely at my
own risk and that there shall be NO
liability whatsoever on the part of the Promoter, World Powerlifting
Federation, Mexican Powerlifting Organization, its officers, employees or
agents for any loss, damage or injury suffered by me, howsoever caused.
6.
That I know of no reason why
I should not take part on the grounds of ill health.
7.
I enclose my $ 700 pesos
entry fee payable to the Mexican Powerlifting Organization, which is
non-refundable.
8.
All entry forms and fees to
be sent to be sent to the Mexican Powerlifting Organization, to be received by NO LATER than 26th
October 2004.
Signature______________________________________________________
Date_________________________
I am the Parent/Guardian
of______________________________________________________________________
Named above who is under 18 years of age and I
confirm acceptance of the above terms on his/her behalf.
Signature______________________________________________________Date___________________________