For information call David Peterson at (517) 627-3816.
Make check payable and mail to:
David Peterson
12497 Broadbent Road
Lansing, MI 48917
Please enter me in ____________ kg. weight class
Name ______________________________________ Phone ______________ Age _________
Address ______________________________________________________________________
City ____________________________________________ State ________ Zip ____________
Club __________________________________________ Current USAW Card # ____________
Please read and sign below. This blank must have your signature.
In consideration of your accepting this entry, I understand the risk of injury in competition, and waive and release any and all rights and claims for damages that I may have against the Michigan Fitness Foundation dba GLSG, U.S. and Michigan Weightlifting Federations, Lansing Catholic Central High School, the Lansing Cougars WLC, or any administrators of this meet for any and all injuries that I may suffer at this competition.
_____________________________________________________________________________
Parental Signature (if under age 18)
Date
_____________________________________________________________________________
Signature of Entrant
Date