The Elmira Super Total
Elmira, NY 14904
We are holding a USAW weightlifting meet on Saturday April 12th and an AAU powerlifting meet Sunday April 13th. If you compete in both you will be eligible to earn awards for The Super Total. If you do both full meets the cost will be $65.
Elmira Challenge Weightlifting Meet
USAW Olympic WeightLifting Meet
April 12, 2014
Weigh-Ins 8:00A.M. – 9:00 A.M.
Lifting starts at 10:00 A.M.
828 Erie St. Elmira NY
Call 735-9789 for details
DATE: April 12 2014
VENUE: Jim’s Gym/CrossFit607
ENTRY FEES: $25,$65 for Super Total Entries must be postmarked by April 1 ($10 additional late entry fee)
Fee must accompany entries – Payable to : Jim’s Gym
Mail to: Jim Wheaton , 828 Erie St, Elmira NY 14904
Email Questions to : CrossFit607@gmail.com
Call with Questions to: 607-735-9789
Weigh ins 8:00-9:00am
Weight classes: Men 56, 62, 69, 77, 85, 94, 105, 105+ Woman: 48, 53, 58, 63, 69, 75, 75+
**** BRING YOUR USAW CARD WITH YOU TO THE MEET ****
Please enter me in the _________ kg category for this meet. In consideration of my entry in the 607 Open Weightlifting Championships (individually and collectively, the “competition”). I certify that I am sufficiently physically fit to participate in the competition and I (and my parent or guardian, if I am a minor) hereby waive and release USA Weightlifting (the USAW), its directors, officers, officials and agents, the Niagara LWC, Jim’s Gym, CrossFit 607, and the competition’s sponsors and organizers of and from any cause of action, loss, liability, claim demand or expense of any kind whatsoever which I or my heirs or personal representatives may have bodily injury or illness and for any other cost, damage or loss suffered or incurred by me or on my behalf in connection with my travel to and from, and my participation in, the Competition and all related activities. The foregoing waiver and release shall not apply to injuries, damages and losses resulting from injuries or medical expenses covered by accidental death, dismemberment and/or loss of sight and medical insurance policies maintained by the USAW.
I (and my parents or guardian, if I am a minor) agree that the USAW and its agents, including the Competition’s sponsors and organizers, may make judgments (with
appropriate advice from available medical personnel) with respect to my treatment, hospitalization or other medical care in the event of my illness or accidental injury in connection with my participation in the Competition, if I become disabled or incompetent to make necessary and appropriate decisions for me as though they stood in a relationship to me of parent, guardian or next of kin if circumstances require the USAW, its agents or the Competition’s sponsors or organizers to make such judgments, and my next of kin (or my parent or guardian, if I am a minor) hereby release and agree to hold the USAW and its agents, Jim’s Gym/CrossFit607, and the Competition’s sponsors and organizers harmless from and against any expense, cause of action, liability, claim, demand or expense arising from good faith judgments made by the USAW, its agents and/or the Competition’s sponsors and organizers concerning the treatment, hospitalization and/or medical care in the event of any illness, injury or other emergency circumstance in connection with the Competition.
I (and my parent or guardian, if I am a minor) agree that I (and my parent or guardian, if I am a minor) will be financially responsible for treatment, hospitalization and other medical care rendered to me in the event of my illness, injury or other medical emergency circumstances in connection with the Competition, except to the extent my injuries and medical expenses, if any, are covered by accidental death, dismemberment and/or loss of sight and medical reimbursement insurance policies maintained by the USAW for my benefit, in which event I (and my parent or guardian, if I am a minor) nevertheless will continue to be financially responsible for expenses of treatment, hospitalization and other medical care in excess of such policies’ limits.
PLEASE TYPE OR PRINT ALL INFORMATION CLEARLY
DATE OF BIRTH________________AGE______
USAW NUMBER___________USAW MEMBER EXPIRATION DATE_______________
USAW CLUB AFFILIATION_____________None___________
ATHLETES UNDER AGE 18 MUST HAVE THE FOLLOWING SECTION COMPLETED BY THEIR PARENT OR LEGAL GUARDIAN.
(For athletes of minority age) I have explained to my son/daughter the aforementioned release and activity and their ramifications, and I further consent to his or her registration for this USAW activity under the conditions and their ramifications, and I further consent to his or her registration for this USAW activity under the conditions stipulated above.
PRINTED NAME_______________________________________ PARENT_____GUARDIAN_____
The Elmira Challenge Powerlifting Meet
Arpil 13th, 2014
Elmira, NY 14904
Men’s: 114 123 132 148 165 181 198 220 242 275 308 308+
Woman’s: 97 105 114 123 132 148 165 181 198 220 220+
Teen: 11 and Under 12-13 14-15 16-17 18-19 Junior 20-23
Sub Masters: 35-39 40-44 45-49 50-54 55-59 60-64 65+
Open Raw Equiped
Testing: Any AAU lifter may be subject to drug testing per the AAU Policy and Procedures.
Rules: AAU Rules Apply Please Visit The AAU Website For Complete Rules
Uniform: One piece lifting singlet, t-shirt/one ply polyester bench shirt, no records will be set without proper attire. Raw lifters are required to wear t-shirts in all three events.
Entry Fee: Bench only: $40 Deadlift only: $40
Squat only: $40 Push/Pull:$45 Full Meet: $50 Super Total: $65
Extra Division: $25
Checks/Money Orders Made payable to Jim’s Gym, 828 Erie St. Elmira, NY 14904
We can also accept CC: Visa, MC
Weigh-ins: 8:30A.M Lifting will start at 10:00 A.M.
Name:______________________________________________ Age:____________ AAU#___________
Circle Appropriate Details:
Mens: 114 123 132 148 165 181 198 220 242 275 308 308+
Women: 97 105 114 123 132 148 165 181 198 220 220+
Teen: 11 and Under 12-13 14-15 16-17 18-19 Junior: 20-23
Submasters: 35-39 Masters: 40-44 45-49 50-54 55-59 60-64 65+
Open Raw Equipped
AAU CARDS All lifters must have a current AAU membership card. Adults: Adults must apply online at AAUSports.org. All competitors age 20+ will have a background check performed. Add a week for the background check prior to card approval. Youth: Youth (ages 6 to 19) may obtain their cards online up until the competition. If you are at the meet and don’t have a card yet, use a smart phone and credit card to obtain your card prior to the official weigh-in. Note: The cost of an AAU card is $24 for Adults and $16 for youth.
• This event is sanctioned by the Amateur Athletic Union of the U.S., Inc.
• All participants must have a current AAU membership.
• AAU membership may not be included as part of the entry fee to the event.
• AAU membership must be obtained before the competition begins except where the event operator has a laptop available with an internet connection.
• Participants are encouraged to visit the AAU web site www.aausports.org to obtain their membership
- BE PREPARED! Adult and Non Athlete memberships are no longer instant and cannot be applied for at event. Please allow at least 10 days for membership to be processed.
AAU Powerlifting Waiver and Consent
In order to be able to participate in this or any other AAU Powerlifting event, I hereby consent to be drug tested by urine analysis or whatever other method is chosen by the AAUPC. I agree if I fail or refuse to be tested that I will automatically be disqualified from the event(s) and may be subject to further penalties under the AAU Code. I further consent to the publication of my test results and/or my failure/refusal to test in sole discretion of the AAUPC. I understand that both the collection process and testing procedures will be performed by a third party (not AAUPC or AAU)
I hereby release, discharge and covenant not to sue the AAUPC and/or the AAU, their respective administrators, directors, agents, officers, members, volunteers, employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of the premises on which any AAU activity takes place (each considered one of the releases) , from all liability, claims, demands, losses, or damages on any account caused or alleged to be caused in whole or in part by any and all of the releases or otherwise, relative to the drug testing, the publication(s0, or any matter related to this event, and further agree that if, despite this release and waiver of liability, assumption of risk and indemnity agreement, such a claim is made against any of the releases, the undersigned will indemnify, save and hold harmless each of the releases from any litigation expenses, attorneys fees, loss, liability, damage, or cost which may occur as a result of such claim. The parties agree that if any portion of the consent/release shall be deemed invalid and/or unenforceable, the rest of such consent/release shall remain in full effect.
Signature of parent or Guardian: _______________________________ if under age 21