2016 UPA Clash of the Titans presented by Madtown Fitness Saturday, June 4 th 2016

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2016 UPA Clash of the Titans presented by Madtown Fitness Saturday, June 4 th 2016 MEET DIRECTOR: EVENT LOCATION: ELIGIBILITY: WEIGH-IN: EVENT START TIME: Dan Pasholk (Madtown Fitness) (608) 270-9606

1 2016 UPA Clash of the Titans presented by Madtown Fitness Saturday, June 4 th 2016 MEET DIRECTOR: EVENT LOCATION: ELIGIBILITY: WEIGH-IN: EVENT START TIME: Dan Pasholk (Madtown Fitness) (608) MadtownFitnessGym@gmail.com UW Parkside Black Box Theater 900 Wood Road, Kenosha, WI All entries must have a valid UPA registration card and must present proof at weigh-in. Fee is $30 per card, $15 for High School divisions. Registration will be available at weigh-ins. 24-HOUR WEIGH-IN RULE APPLIES Weigh-ins will be held at the Racine Marriott (7111 Washington Ave, Racine, WI 53406) on Friday June 3rd, 10 AM 1 PM and 5 PM 7 PM *Bring uniform & all equipment to weigh-in for approval. All Lifters - Saturday June 4th at 10 AM **Mandatory Rules Meeting at 9:30 AM

2 CONTEST LIFTS: MEET HOTEL: AWARDS: RULES: ENTRY FEE: Ironman (Push/ Pull), Bench only, Deadlift only *For this meet there will be NO UPA-AD (tested) division. Add $30 for each additional division. No official hotel, numerous options available in the area. 1 st 3 rd in Men s & Women s Ironman and Bench only divisions by weight class and total. 1 st 3 rd all age divisions by Schwartz Formula. Best Lifters by Schwartz Formula. Check for information and rulebook A fee of $85 must accompany this entry form for Ironman (Push/ Pull) or $65 for Bench only OR Deadlift only. *For this meet there will be NO UPA-AD (tested) division. Add $30 for each additional division. UNIFORM: Must have a one piece lifting suit or singlet. A $30 late fee will be charged for entries received after May 14th, Entried received after May 25 th will NOT be accepted! NO REFUNDS ON ENTRY FEES **NO EXCEPTIONS** OPEN AND AGE DIVISIONS ONLY. NO AD (DRUG TESTED) DIVISION

3 2016 UPA Clash of the Titans presented by Madtown Fitness June 4 th, 2016 Mail entry to: Madtown Fitness 802 Stewart St Madison, WI First Name: Last Name: Address: City: State: Zip: Phone: Alternate Phone: Date of Birth: Age at time of competition: Team: Sponsors: DIVISION(s) Ironman (Bench Press and Deadlift Bench Press Only Deadlift Only Open Junior (20-23) Teenage (Circle One) Masters (Circle One) WEIGHT CLASS (Circle One) Men Women SHW 308 SHW UPA # Exp Date:

4 ENTRY FEE (Check ALL That Apply) Ironman (Push/Pull) ($85) Bench Press ONLY ($65) Deadlift ONLY ($65) UPA Card ($30) ($15 for Teen UPA Card) Late Fee ($30) if submitting after May 14 th, 2016 TOTAL: Mail to: Madtown Fitness 802 Stewart St Madison, WI Checks are preferred. Please do not send cash through the mail. Make checks payable to Madtown Fitness.

5 Release and Waiver In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors, and administrators waive and release any and all rights and claims for damages I may have against the United Powerlifting Association LLC, Meet Director Dan Pasholk, Madtown Fitness Gym, event staff, their representatives, successors, and assigns for any and all injuries or bodily harm that I might suffer while competing at the UPA IL State Championships held on September 26th, I understand that powerlifting is a physically demanding sport with inherent risks and certify I am capable of participating. I understand there is random drug testing by urinalysis on a minimum of 10% of all UPA-AD division lifters. The UPA will permanently ban from the UPA-AD division any lifter testing positive for a prohibited substance. Signature: Date: Parent Signature if under 18 years old Date: For updates on the meet go to MFGYM.NET, or join the event page on facebook. Event page can be found through facebook.com/madtownfitness

UPA Old School Iron Gym Winter Rack Attack 2017!

UPA Old School Iron Gym Winter Rack Attack 2017! MEET DIRECTORS: TJ Slomka - osigym@yahoo.com (216) 392-0981 Luz Miller - msmillie76@gmail.com (216) 322-7264 EVENT LOCATION: ELIGIBILITY: WEIGH-IN: Title