Ohio Raw Championship Qualifier
3/27/2010
This is an open, raw, full meet. Teen, Women’s, Open, Master’s class will be available for State and National records. Registration deadline is 3/15-same day athletes will be turned away. Mail check or money order to; Gorilla Pit 7472 Tyler Blvd. Mentor, OH. 44060.
Registration Fee for all three lifts is $65.00 or $30.00 for single event registration, made payable to Gorilla Pit. All lifters must be APC members, (membership cards will be available at the meet) $30.00 adult and $15.00 teen. Registration form can also be found on APC website at
http://americanpowerliftingcommittee.com/ under forms.
Name Print: ____________________________________ Age:____________
Weight Class: ___________________________________ Lifts Entering SQ ( ) BP ( ) DL ( )
Total Cost for your entry: _______________ Shirt Size L__ XL__ XXL__ XXXL__
Address: ____________________________________________ City ______________________
State ___________ Zip ___________ Phone ___________________________
Email _________________________________________________________________________
Emergency Contact Name ______________________________ Phone ____________________
Lifter Consent Waiver
By entering this contest I realize that a Powerlifting Contest of this nature is a dangerous sport where serious injury and/or death may occur. In consideration of your acceptance of this entry, I hereby, for myself, my heirs, executors and administrators, and my assignees, waive and release all rights and damages I may have against Bryce Kujat, Ty Phillips, Marriott Comfort Inn, Gorilla Pit Strength Sports, Gorilla Pit LLC, American Powerlifting Committee, any and all sponsors of the event, their representatives and assigns, for any and all injuries incurred by me in conjunction with these championships and in traveling to and from the event. And in further consideration of permission being granted to me to participate in the Ohio Raw Championship Qualifier and its related events, I further agree to hold harmless, waive and release rights (photo, name and likeness), for media (newspapers, TV, radio, and/ or magazines). I have carefully read this information and understand it. I thus affix my signature below.
Athlete Signature (guardian) _______________________________ Date ___________
Location of Meet: Comfort Inn & Suites 7701 Reynolds Road SR 306 , Mentor, OH, US, 44060 Call for reservations and rates: Phone: (440) 951-7333
Weigh In will be held at Gorilla Pit 7472 Tyler Blvd, Mentor, OH. 44060, the night prior to the meet. Weigh in will be from 7pm until 8pm. If you miss the weigh in, you will be automatically disqualified and registration fees are NOT refundable. For weight on the registration, this will be your competition weight.
APC Raw rules apply-knee wraps or sleeves, wrist wraps and belt, singlet and T-shirt.
Rules meeting will be held at 10am 3.27 and lifting will start PROMPTLY at 10:30am.
For questions or concerns please email gorillapitps@gmail.com or call 216-310-2283 and ask for Ty.