New Year Power Bash
Registration Form
Meet Site:
Mountain Island Fitness, 10030 Callabridge Court, Charlotte, NC
When:
Saturday January 22, 2022
Meet Hosts:
Marc Anderson
365 SWPF President & Meet Director:
Bill Clary Contact #: 704.236.1899
Sanction by:
365 Strong World Powerlifting Federation (365 SWPF)
Gear Options: >Raw
(knee sleeves)
>Raw Classic
(knee wraps)
>Single-Ply >Multi-Ply
Lifting Classification:
>"Tested"
(subject to drug test) and
>"Untested"
(no drug test given)
Featured Competition:
>FULL POWER >PUSH PULL >SQUAT ONLY >BENCH ONLY >DEADLIFT ONLY >STRICT CURL ONLY
Early Weigh–Ins:
Friday, January 21, 2022: 10:30am – 12:30pm
and
4:00pm – 6:00pm (@ meet site)
Late Weigh-ins:
Saturday, January 22, 2022: 7:00am-8:00am (@ meet site)
Divisions:
>Open >Juniors
(20-23)
>Sub-Masters
(35-39)
>Novice >Masters >M/P/F >Teenage >Youth
(11-12)
>Para-Lifters >Kids Club
Membership:
(at 365strong.org) Apply online, VIP Lifetime Membership-$55 (one-time fee) or Annual Membership-$
30
(renew annually)
Standard Full Power Entry Fee:
$
100
for one division
Full Power M/P/F, Teens, Youth, Para-Lifters and Push Pull, SQT, BP and DL Only Entry Fee:
$
85
for one division
Crossover and/or Standing Curl Fee: The "Crossover" and/or Standing Curl fee:
$
50
Kids Club Participants: $
25
Deadline/Late Entries:
All Entries MUST be received by
January 10, 2022
or be charged a Late Entry Fee of $50. NO ENTRIES accepted the WEEK OF the MEET
Uniform:
Mandatory - Must have one piece lifting suit or wrestling singlet. 365 SWPF rules apply @ 365strong.org.
Mandatory rules briefing:
Saturday @ 8:00am; Lifting Begins at approximately 9am (upon completion of warmups)
Awards:
Separate Tested and Untested Divisions: 1-3rd place all Division Weight Classes, formulas are used for naming the Best Male & Female Lifters
Meet Flight Splits:
Will be announced to all competitors the week of the event
Online Registration:
Go to
www.365strong.org
website "Upcoming Events" page and follow instructions to pay via PayPal; or
Mail Check
to: “365 SWPF”, PO Box 253, Fort Mill, SC 29716
Contact Numbers:
Bill Clary: 704.236.1899, Email:
info@365strong.org
Website:
www.365strong.org
RELEASE OF LIABILITY WAIVER (READ BEFORE SIGNING and return with entry form with entry fee)
In consideration of being allowed to participate in any way in the
2022 New Year Power Bash
, Sanctioned by 365 Strong World Powerlifting Federation, its related events and activities, I The undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this event is possible and while particular skills, equipment, and personal discipline may reduce this risk, the risk of injury or illness does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation and lift attempts; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the 365 SWPF officials immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE host Mountain Island Fitness and owner Marc Anderson, 365 SWPF President Bill Clary, 365 Strong World Powerlifting Federation LLC, Charlotte, NC, any venue representatives, all 365 SWPF officers, meet referees, all event personnel, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releases"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Name
Address:
City, State, Zip:
Email
Phone
Other Phone
Date of Birth:
Home (Team) Gym:
Competitive Highlight:
Records:
Meet Personal Bests:
Post your meet PR's for full power or single or combo lift events.
Membership Status:
Enter Yes (I am a member) or No (Not yet a member)
Lifting Classification:
Tested
Untested
Lifting Preference:
You may change your preference at weigh-ins.
Raw (knee sleeves permitted)
Raw Classic (knee wraps permitted)
Single-Ply
Multi-Ply
Competition Categories Entering:
Making more than one selections (except the curl) constitutes paying a crossover fee.
Full Power
Push Pull (BP & DL only)
Squat Only
Bench Press Only
Deadlift Only
Standing Curl Only
Division Categories Entering:
Open
Juniors (20-23)
Sub-Masters (35-39)
Masters
M/P/F
Novice
Teenage (13-19)
Youth (11-12)
Para-Lifter
Kids Club (deadlift only)
Men's Weight Class Entering:
114.5lb/52kg
123.5lb/56kg
132.25lb/60kg
148.75lb/67.5kg
165.25lb/75kg
181.75lb/82.5kg
198.25lb/90kg
220.25lb/100kg
242.5lb/110kg
275.5lb/125kg
308.75lb/140kg
308.8+lb/140.1+kg
Women's Weight Class Entering:
97.0 lb/44kg
105.75lb/48kg
114.5lb/52kg
123.5lb/56kg
132.25lb/60kg
148.75lb/67.5kg
165.25lb/75kg
181.75lb/82.5kg
198.25lb/90kg
198.3+lb/90.1+kg
I agree to abide by all terms of the Entry Information and the Waiver General Release:
YES
NO
Meet T-Shirt Size:
Adult S
Adult M
Adult L
Adult XL
Adult 2-XL
Adult 3-XL
Kids Size (enter in comments)
Walk-up Lifting Song
Please provide the name of your song and artist.
Lifter Name Confirmation
Parent or Guardian Approval (if under 18 years old)
Comments
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