2019 UPA Michigan State Championships

Send entry fee via PayPal to detroit_barbell@yahoo.com

Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Choose 1
Choose 1
Choose 1 Raw - with wraps Elite Raw - naked knee/sleeves
Event *
$50 for each additional division
Choose 1. Males choose "Male - N/A"
Choose 1. Females select "Female - N/A"
Choose 1
Signature *
Signature
In consideration of the acceptance of this entry thereby for myself, my heirs, executors, and administrators waive and release any and all claims and damages I may have against the UPA, Jeremy Thomas, Harlan Brandenburg, Detroit Barbell and the Brownstown Sports Center, their representatives, successors, and assigns for any and all injuries or bodily harm that I may suffer while competing at the 2019 UPA Michigan State Championships. I attest and verify that I have full knowledge of the risks involved with my participation in this event, and that to the best of my knowledge I am physically fit and able to participate in this event. I also acknowledge that my entry is not secured until my payment is received.
If yes, add $40 to payment. You MUST have a current UPA membership in order to compete.