2018 Detroit Barbell Open

PayPal entries to detroit_barbell@yahoo.com

Mail checks payable Detroit Barbell - 7600 Gary Ave | Westland, MI 48185

Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Choose 1
Event *
Choose at least 1. $50 for each additional sanction/division
Division *
Choose at least 1. $50 for each additional sanction/division
Choose 1. Males choose "Male - N/A"
Choose 1. Females select "Female - N/A"
Age Division *
Choose at least 1. $50 for each additional sanction/division
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, the Brownstown Sports Center & their representatives, successors, and assigns for any and all injuries or bodily harm that I may suffer while competing in the 2018 UPA Detroit Barbell Open. 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 understand that submission of this form doesn't secure my entry. Entry is secured by payment received.