2011 Georgia-Alabama
LWC
Weightlifting Championship
Saturday, December 17, 2010
|
VENUE |
Anderson/Cohen Weightlifting
Center Savannah, GA |
| SPONSORED BY: |
Team Savannah and Chatham County Parks & Rec |
| MEET DIRECTOR | Howard Cohen |
| ENTRY FEES | Individual - $20.00 (NON REFUNDABLE) |
| ENTRY DEADLINE | December 6, 2011 |
| CHECK PAYABLE TO: | Howard Cohen |
| MAIL TO: | Howard Cohen 130 Brandywine Road Savannah, GA 31405 912-354-8072 |
DEADLINE FOR ENTRY IS DECEMBER 9TH. NO EXCEPTIONS!!
**********************************************************************
LWC Meeting at Venue at 12:00PM
SATURDAY, December 17, 2010
| Session | Gender | Weigh In | Lift |
| 1 | ALL MEN 13 & Under | 8:00 AM | 10:00 AM |
| 2 | All Women | 11:00 AM | 1:00 PM |
| -- | LWC Meeting at Venue at 12:00PM | --- | ---- |
| 3 | MEN 14 &
Up 77KG & Below |
12:00 PM | 2:00 PM |
| 4 | Men 85kg and Above | 2:00 PM | 4:00 PM |
GA-AL LWC Weightlifting Championship
Saturday, December 17, 2010
OFFICIAL ENTRY FORM
WEIGHT CLASS: ________________KG (You can only enter one)
NAME__________________________________________________ USAW #_______________
(Last)
(First)
(Middle)
Athlete’s Signature:_______________________________________________ Date:______________
e-mail:____________________________________________________________________________
ADDRESS__________________________________________________________________________
CITY_____________________________________ STATE_________ ZIP________________
PHONE (_______)__________ E-MAIL __________________________ AGE_______ DOB_________
COACH: __________________________________________________________________________
WILL THIS BE YOUR COACH AT THIS MEET? __YES __ NO (If no, then
whom?)____________
Coach’s USAW #___________
USA WEIGHTLIFTING CLUB AFFILIATION__________________________________ CLUB #:____________
__ MALE __ FEMALE *U S. CITIZEN: __ YES __ NO
______School-age _______Junior ______Senior _______Master
*Athletes must be U.S. Citizens to compete*
UNDER AGE ATHLETES
ATHLETES UNDER 18 YEARS OF AGE MUST HAVE THE FOLLOWING SECTION COMPLETED BY A PARENT OR GUARDIAN
I have explained to my son/daughter the aforementioned releases and conditions and their ramifications and I further consent to his/her registration for this USA Weightlifting activity under the above stipulated conditions.
SIGNATURE_____________________________________________________________ DATE__________________
PRINTED NAME: _______________________________________________________________ (Parent or Guardian)
IF YOU ARE UNDER 18 YEARS AND YOU HAVE FAILED TO HAVE YOUR PARENT OR GUARDIAN SIGN THIS RELEASE, YOU WILL NOT BE PERMITTED TO LIFT or COMPETE.
FOR USA WEIGHTLIFTING MEMBERSHIP
APPLICATION, SEE YOUR COACH,
OR VISIT WWW.USAWEIGHTLIFTING.ORG