Name *
Name
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Address
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Phone
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Date of Birth
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Release of Liability Statement
Release of Liability. Read Carefully. By accepting the following terms you will be giving up important rights. In consideration of acceptance of my entry form in the benchpress competition, I understand that I am legally bound for not only my own actions, but also for my heirs, my executors, and my administrators. In agreeing to this release from liability, I waive and release Stephen Parkhurst, Jodi Parkhurst, WUAP-USA Inc., the WUAP International Inc., the Contest Venue Location and staff, all officials, referees, spotters/loaders, and any other person or firm taking part in the competition from any and all liability which may arise from your participation in above stated the competition. I understand all of the above statements for my acceptance of my entry in this competition. By agreeing to this statement, I affirm that all information of this form is correct. I understand I may be required to sign a release of liability form during my weigh-in session.
Entry Payment Statement *
I understand that I must submit my payment to the Chicagoland Open BenchPress and Deadlift Championships at the same time as I submit this entry form. I understand I must use the PayPal method provided. I understand I do not need a PayPal Account to use PayPal.

BE SURE TO SUBMIT YOUR ENTRY FORM BY SELECTING THE "SUBMIT ENTRY FORM BUTTON" ABOVE BEFORE SELECTING THE PAYPAL OPTION BELOW. FAILURE TO DO SO WILL CLEAR THE INFORMATION FROM THE ENTRY FORM. YOU CAN RETURN TO THIS PAGE ANYTIME TO COMPLETE THE PAYPAL OPTIONS.

WUAP-USA NorthWest Houston Open Championships