Northeast USA Regional
Meet Registration Form
Event Host:  Skiba's Gym, 625 Roosevelt Ave., Carteret, NJ 07008 
Venue Location:  Rahway Recreation Center, Rahway, NJ
Gym Owner & Contact Phone #:  Henri Skiba, (732) 598-9369
Event Date:
  Saturday April 22, 2023  
Federation President: Bill Clary  
Sanction by:  365 Strong World Powerlifting Federation (365 SWPF) 
Division Classifications:  Drug “Tested” (Drug test consent) or “Untested” (No drug test) 
Divisions:  >Open  >Juniors (20-23)  >Submasters (35-39) >Novice  >Masters (40+)  >Teenage  >M/P/F  >Youth (10-12)  >Para-Lifter (Special Olympian)  >Kids Club (10 & under) 
Comp Categories:  >Push Pull    >Bench Only    >Deadlift Only    >Strict Curl
Gear Categories:
  >Raw    >Single-Ply    >Multi-Ply
Early Weigh–Ins: Friday April 21, 2023: 10:00am – 12:00pm and 4:00pm – 6:00pm (at Rahway Recreation Center)  
Late Weigh-Ins (advanced approval necessary): Saturday April 22nd (Meet Day) from 7:00-8:00am (at meet venue)
Eligibility:  Open to all athletes with a current Annual or Lifetime Membership 
Standard Registration Fee:  $105 
M/P/F, Para-Lifters, Youth & Teen Full Power and Squat, Bench & Deadlift Only Entry Fee:  $90
Strict Curl Entry Fee:  $50
Crossover Fee:  $30
Kids Club Entry Fee:  $25.00
Team Entry Fee:  $60 (minimum 4 per team, maximum 11 per team with 2 alternates)
Deadline/Late Entries:  All Entries MUST be received by April 8, 2023 or be charged a Late Entry Fee of $25. No lifter registration permitted after April 16th or once the roster limit of 50 has been reached! REGISTER EARLY TO LOCK IN ROSTER SPOT!! 
Uniform: Mandatory - Must have one piece lifting suit or wrestling singlet. 365 SWPF rules apply @ 365strong.org.
Agenda: The mandatory meeting is on Saturday @ 8:00 am; Lifting begins at approximately 9:00am
Awards: 1st thru 3rd place for each division and weight class. Best Lifter and Team awards.
Methods of Payment:  PayPal Online Payment (preferred): 365strong.org go to the meet event page or mail check or money order to "365 Strong Powerlifting" at PO Box 253, Fort Mill, SC 29716
Federation Contact Number:  Bill Clary: (704) 236-1899 
Federation Website / Email:  Website: www.365strong.org and Email: info@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 the Northeast USA Regional, Sanctioned by the 365 SWPF, its related events and activities, I The undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury 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, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant illness or 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 Meet Director/Promoter Bill Clary, 365 Strong World Powerlifting Federation, Skiba's Gym, gym owner Henri Skiba, all gym personnel, Rahway Recreation Center, Venue personnel, 365 SWPF officers, officials, 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, ILLNESS, 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. 

All videos (including live streaming) and photos must be pre-approved in advance by the meet director or federation president.  

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.

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.