Athlete Registration USA Powerlifting Midwest Regional RAW & EQUIPPED POWERLIFTING COMPETITION SANCTION# RG-2019-07 Renaissance Airport Hotel, August 2-4, 2019 Meet Director: Chris Thacker, 314-750-3143, chris@labgym.com Description: The 2019 Midwest Regional is a Raw & Equipped, Full Meet ONLY Competition. Divisions: Open: 14+ Juniors: 20-23 Y1: 8-13 M1: 40-49 Y2: 10-11 M2: 50-59 Y3: 12-13 M3: 60-69 T1: 14-15 M4: 70-79 T2: 16-17 M5: 80+ T3: 18-19 Weight Classes: Women: 43kg, 47, 52, 57, 63, 72, 84, 84+ Men: 53kg, 59, 66, 74, 83, 93, 105, 120, 120+ Awards: Medals will be awarded to the top 1-3 in each weight class/division for Youth, Teen, Junior, Open and Masters Fees & Requirements: $125.00 + $15.00 each additional division Late Entry add $35 No refunds USAPL Membership IS required (click here to purchase) IMPORTANT: There will be no USAPL Memberships sold or renewed at the meet. You must have a valid USAPL Membership to compete. DRUG TESTING: On your honor as an athlete you have not used any strength inducing drugs as part of your training during the last 36 months prior to the date of this meet to be eligible, nor have you used any prescription diuretics or psycho-motor stimulants during the 7 days prior to this meet. At least 10% of all lifters will be tested by urinalysis. Banned substances include but are not limited to anabolic steroids, natural and/or synthetic growth hormones. If you are on any medications, please verify if that substance is permissible or not. The complete list of banned substances is available on the website of the World Anti- Doping Agency. LIFITING ATTIRE: All equipment must conform to USA Powerlifting rules and fall within the technical specifications of the IPF approved list. You can download that HERE. NOTICE: ENTRY DEADLINE IS June 30th. NO EXCEPTIONS. ANY LATE ENTRIES THAT MIGHT BE CONSIDERED WILL REQUIRE AN ADDTIONAL $35.00/FEE Athlete’s First Name Athlete’s Last Name GenderSelect…MaleFemale Date of Birth Address City StateSelect…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareD.C.FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew MexicoNew JerseyNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon(AU) Australian Capital Territory(AU) New South Wales(AU) Victoria(AU) Queensland(AU) Northern Territory(AU) Western Australia(AU) South Australia(AU) Tasmania(ZA) Gauteng(ZA) Western Cape(ZA) Eastern Cape(ZA) KwaZulu Natal(ZA) North West(ZA) Northern Cape(ZA) Mpumalanga(ZA) Free StateMy State is not listed Zip Code Phone Number Email Emergency Contact Relationship Emergency Contact Phone Number Powerlifting Club/Team: Coach’s Name: Coach’s Phone # Coach’s Email address Equipped or Raw?Select…EquippedRaw DivisionSelect…R-Y1R-Y2R-Y3R-T1R-T2R-T3R-JRR-OR-M1aR-M1bR-M2aR-M2bR-M3aR-M3bR-M4aR-M4bR-M5aR-M5b Equipped Division Select…-T1-T2-T3-O-M1a-M1b-M2a-M2b-M3a-M3b-M4a-M4b-M5a-M5b Weight Class: Women’sSelect…4347525763728484+ Weight Class: Men’sSelect…535966748393105120120+ Are you participating in multiple divisions?Select…YesNo Additional DivisionSelect…JuniorOpenMasters Squat Rack HeightSelect…123456789101112131415161718192021222324252627Eleiko Combo Rack Bench Rack HeightSelect…123456789101112131415161718192021222324252627Eleiko Combo Rack Bench Blocks?Select…YesNo Opening Squat Attempt (kg)This is not final and will be verified again at weigh ins Opening Bench Attempt (kg)This is not final and will be verified again at weigh ins Opening Deadlift Attempt (kg)This is not final and will be verified again at weigh ins Best Total (kg) Are You a Current USA Powerlifting Member?Select…YesNo USAPL Member Number IF You are participating in a Sanctioned USAPL event, you are required to be a current USA Powerlifting Member. Click USAPL Furthermore, USAPL will not recognize your efforts if you are not a member. So, Welcome to the Club!! IT IS VERY STRONGLY SUGGESTED TO HAVE PURCHASED THIS BEFORE YOU ARRIVE. TECHNICAL ISSUES CAN ARISE AND MEMBERSHIPS WILL NOT BE SOLD AT THE EVENT. It is preferred that you have this when you submit your entry to help expidite the process. Billing Address Billing Address 2 Billing City Billing Zip Billing StateSelect…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareD.C.FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew MexicoNew JerseyNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon(AU) Australian Capital Territory(AU) New South Wales(AU) Victoria(AU) Queensland(AU) Northern Territory(AU) Western Australia(AU) South Australia(AU) Tasmania(ZA) Gauteng(ZA) Western Cape(ZA) Eastern Cape(ZA) KwaZulu Natal(ZA) North West(ZA) Northern Cape(ZA) Mpumalanga(ZA) Free StateMy State is not listed Billing CountrySelect…United StatesCanadaUnited KingdomAfghanistanÅlandAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatia (Local Name: Hrvatska)CubaCuracaoCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRepublic of the CongoRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaSão Tomé and PríncipeTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Minor Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Enter Your Billing Information Card Number CVC Exp. Month01 – January02 – February03 – March04 – April05 – May06 – June07 – July08 – August09 – September10 – October11 – November12 – December Exp. Year20192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041 Share this:FacebookTwitterWhatsAppEmailLike this:Like Loading...