POWERLIFTING OFFICIAL TEAM ENTRY FORM

 

Region______________________________                              Date______________________________

 

North/South__________________________

 

State________________________________

 

School_______________________________                  Coach__________________________________

 

 Last Name

First Name

Weight Class

1.

 

 

2.

 

 

3.

 

 

4.

 

 

5.

 

 

6.

 

 

7.

 

 

8.

 

 

9.

 

 

10.

 

 

11.

 

 

12.

 

 

 

Entries must be received 7 days prior to the meet.
 Entry Fees:                      Regional  -  $150.00   (1 – 12 lifters)     

                                  North/South -       $50.00   (1 – 3 lifters) 

                                                              $75.00   (4 – 6 lifters)

                                                            $150.00   (7 – 12 lifters) 

                                       State -             $50.00   (1 – 3 lifters)                                        

                                                               $75.00  (4 - 6 lifters)
                                                             $150.00   (7 – 12 lifters)   

                                             

Principal’s Signature________________________________________________