World United Ameteur Powerlifting

EuropeanChampionships 2014

June12-15, Uzhgorod, Ukraine

Entryform

Lastname: ______Firstname: ______

Adress: ______City/Country: ______

Birthdate: ___/___/_____ Age: ______

Day Month Year

Sex:□ female □ male

Weightclass:

48 52 only 56 60 67,5 75 82,5 90 90+ only 100 110 125 140 140+

□ □ woman □ □ □ □ □ □ □ woman □ □ □ □ □

Agecategorie:

TeenagerJuniorOpenSubmaster Masters

□ 16-17, 18-19 □ 20-23 □ □ 35-39□

Entryfee: Benchpress: □ € 75,-Powerlifting: □ € 75,-

(Please mark)

Deadline for the entryform and fee: 21.05.2014.

After21.05.2014 no late entry’s will be accepted!

With the nomination the athlete accepts the rules of the federation "United Powerlifter" and is automatically an extraordinarily member of the federation. 10% of the participating athletes will be tested if they are drug free. If somebody should be positive, he/she will be excluded from the meeting; the entry fee will be not returned. The result of the test is final.

Release from Liability. Read this carefully.

By signing this you will be giving up important rights. In consideration of my acceptance of my entry form in this powerlifting/benchpress competition, I understand that I am legally bound for not only myself but also for my heirs, my executors, and my administrators. In signing this release from liability I waive and releasethe promoter and the whole staff, all Officials, Referees, Spotter/Loaders and any other person or firm taking part in this competition from any and all liability which may arise from this competition. I understand all of the above for my acceptance ofmy entry in this competition. By signing this entry form I affirm that all the information on this form is correct.

Signature: ______Date: ______

Parent or guardian if under 18:______

Please send back to:Questions

Sergey OleolenkoPromotor:

88000Sergey Oleolenko

Ukrainska str. 16email:

Ukrainetel: +38 (093) 113-73-28

email: СhiefSecretary:

or fax: +38 (0312) 66-85-50Valeriy Marushka

email:

Bank: OTP Banka Slovensko a.s. IBAN: SK97 5200 0000 0000 1527 1057 BIC: OTPVSKBXXXX

Information to the recipient: WUAP-ME-2014-name competitor

Info: