2008 Npc Northeastern New York Entry Form

Sanction # 8547

THE 2008 NPC NORTHEASTERN NEW YORK Bodybuilding, Fitness & Figure Championships Saturday, November 29th, 2008 – Charles R. Wood Theater – Glens Falls, New York 12801

www.northeasternmuscle.com 518-683-5493

Contest Entry Form Please fill out this form and return it along with your Contest Entry Fee in the amount of $50 in the form of check or money order to the following Address:

134 Jefferson Street-Saratoga Springs, New York 12866 Please make checks payable to the Promoter: Richie Daggs *This contest is an NPC Sanctioned Event. All Competitors must purchase their NPC Membership Card on the day of the event during Athlete Registration/Weigh-In. *The NPC card is a separate fee from the Contest Entry fee, and is payable directly to the NPC. The cost of the NPC Membership card is $80. 1. 2. 3.

Name: Age: Address:

First

__________________________ _____ Mailing __________________________ __________________________ __________________________

Last

________________________

E-Mail

________________________

4.

Gym/Thanks

__________________________

Prior

________________________

5.

Phone:

Home:

(____)_______-___________

Cell:

(____)______-____________

6.

Division:

 Men’s Teen

Men’s Over 40

Men’s Open

 Women’s Open BB

Competitor # _____

Women’s Fitness Open

(Check all that apply)

Figure Teen (18+) Women’s Figure Over 40 Women’s Figure Open Men’s Bench  Women’s Bench

7. Class: (Check all that apply)

 Men’s Bodybuilding Heavy Light Heavy

Middle

Over +198-1/4

+165-1/4 up to 176-1/4 lbs.

+176-1/4 up to 198-1/4 lbs.

.

Welter

Light

+154-1/4 up to 165-1/4 lbs

Under 154-1/4 lbs

 Women’s Bodybuilding Heavy Light-Heavy

Middle

Light

Over 140 lbs.

+115 lbs. up to 125 lbs.

115 lbs. & under

+125 lbs. up to & including 140

 Fitness

A (Up to 5'4")

B (Over 5'4" up to & including 5'6")

C (Over 5'6)

 Figure

A (Up to 5'4")

B (Over 5'4" up to & including 5'6")

C (Over 5'6)

Bench Press

Men’s Weight Classes

Women’s Weight Classes

90.0kg Class from 82.51 to 90.0kg 100.0kg Class from 90.01 to 100.0kg 110.0kg Class from 100.01 to 110.0kg 125.0kg Class from 110.01 to 125.0kg 140.0kg Class from 125.01 to 140.0kg 140.0+kg Class from 140.01 to unlimited

75.0kg Class from 67.51 to 75.0kg 82.5kg Class from 75.01 to 82.5kg 90.0kg Class from 82.51 to 90.0kg 90.0+kg Class from 90.01 to unlimited

In consideration of your acceptance of this entry, I hereby, for myself, my heirs, executors and administrators, and my assignees waive and release all rights and damages I may have against the National Physique Committee of the U.S.A.. Inc.. Richie Daggs, Adirondack Barbell, Bill Crawford, Charles R. Wood Theater, any and all sponsors of the event, their representatives and assignees, for any and all injuries incurred by me in conjunction with the NPC Northeastern New York Bodybuilding, Fitness & Figure Championships, Saturday, November 29th, 2008 and in traveling to and from them. And in further consideration of permission being granted to me to participate in these and related events, I hereby grant NPC. and/or any other NPC approved video or entertainment organization and all of their agents, successors, licensees arid assignees, the right to photograph or otherwise reproduce (whether by film, tape, still photography or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit and / or otherwise exploit any and all media, including without limitation by means of still photography, motion pictures, radio, television, television motion pictures, video printing or any other medium now known or hereafter devised, including also with regard to any merchandising, advertising and/or publicity and the right to use my name and information about me in any connection with any of the foregoing. The rights granted by me hereunder are granted for the entire universe and shall endure in perpetuity and no further compensation shall be payable to me at any time in connection therewith. Nothing contained herein shall be deemed to obligate you, NPC and/or any other NPC approved video or entertainment organization to photograph or otherwise reproduce my voice, appearance or name, or to make use of any of my rights granted herein. I also understand that the aforementioned rights may be reassigned at any time without further consent, I further understand that you, the NPC and/or any other NPC approved video entertainment organization, are videotaping and photographing the Event in express reliance upon the foregoing and I represent and agree that am free to grant the rights granted to you, the NPC and/or any other approved video or entertainment organization hereunder.

SIGNED AND AGREED TO (Date) __________/_______/2008 PRINT NAME _____________________________

SIGNATURE _________________________________