2019 UPA Nationals Registration

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 Detroit Metro Airport Marriott their representatives, successors, and assigns for any and all injuries or bodily harm that I may suffer while competing at the 2019 UPA Nationals. 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 $30 to payment. You MUST have a current UPA membership in order to compete.