100% RAW Powerlifting
Presents….

2017 Midwest Open

Sanction III Event

Powerlifting / Bench / Deadlift / Strict Curl


Meet Director: Jeremey Meyer, 1576 Trumball Terrace,
Plattsmouth, NE 68048 (402) 630-5246

Venue: Holiday Inn at Ameristar Casino * 2202 River Road, Council Bluffs, IA 51503 * (712) 322-5050

Date: Saturday March 18, 2017


Lifting: The Powerlifting, Bench Press, Deadlift & Curl will be done all on the same day. 
Bench Rep challenge & Deadlift Challenge Free to all Competitors.

Time:    Saturday March 18, 2017: Doors open – 8am

Weigh-in: Friday: March 17th  (5-7pm) 
Saturday: March 18th (8-9)am         

Technical Meeting: 9:15am Lifting Starts at 9:45am.

Scales: Professional digital scale

Identification: Photo Identification is necessary for security, to verify every lifter’s entry information, and to help validate drug testing. Acceptable identification includes driver’s license, state ID, school ID, passport. Work ID badges and recreational/social club ID’s are not acceptable.

Federation Membership Fee: Current federation membership is required.  Applications and memberships online.

Entry Fee: All fees should be paid by the
Deadline Date: March 4,2017

Awards: Trophies, Medals, & Sponsor Prize Packages

Singlet is Mandatory ** State, National and World Records

2017 Midwest Open

Sat, March 18, 2017

Holiday Inn at Ameristar Casino 
2202 River Road, Council Bluffs, IA 51503


Meet Director: Jeremey Meyer 402-630-5246 / spcmeyer@yahoo.com

$3.00 Spectator Fee
(18 & Under FREE)

 DRUG FREE EVENT
DRUG TESTING WILL OCCUR

SANCTION II EVENT
STATE RECORDS
NATIONAL RECORDS

Eleiko Calibrated Weights

Ivanko Bar

Texas Deadlift Bar

Strict Curl Plat

Name:*
Date of Birth:*
 / 
 / 
Age at time of meet:*
Address:*
Phone you can typically be reached at:*
-
E-mail:*
RAW Membership Number and Expiration Date: (Enter None, if you are new or your membership has expired.)*
You can purchase or renew your expired membership by going to www.rawpowerlifting.com and clicking on NEW/ReNew Membership.
Gender: *
Bodyweight (pounds):*
DIVISION Check all that apply:*
Select Event (s):*
Meet T-Shirt?*

Rules: 100% RAW rules can be found online or by requesting from our main office. Drug testing will be conducted so be sure to take responsibility for what you put into your body. For help/info contact the USOC hotline at 1-800-233-0393 or www.wada.com.

Minor’s RELEASE


And I, the minor’s parent and/or legal guardian, understand the nature of athletic activities and the minor’s experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the release’s from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged to be caused in whole or in part by the negligence of the “releases” or otherwise, including negligent rescue operations and further agree that if, despite this release. I the minor or anyone on the minor’s behalf makes a claim against any of the releases name above, i will indemnify, save, and hold harmless each of the releases from any litigation expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim.

ATHLETES MUST COMPLETE AND SIGN THE RAW RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY, AND THE PARENTAL CONSENT AGREEMENT (“AGREEMENT”)


Release, Waiver of Liability, Assumption of Risk, Indemnity, and parental Consent Agreement (“agreement”)


In consideration of being permitted to participate in a 100% RAW (“activity”) I, my personal representatives, and assigned heirs and next to kin:


  1. ACKNOWLEDGES, agree, and represent that I understand the nature of the activity and that I am qualified, in good health and in proper physical condition to participate in such activity. I further agree and warrant that if at any time I believe conditions to be unsafe; I will immediately discontinue further participation in the activity.


  1. FULLY UNDERSTAND that: (a) ATHLETIC ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH (“Risks”): (b) these Risks and dangers may be caused by my own actions or in actions of others participating in the activity, the condition in which the activity takes place, or THE NEGLIGENCE OF THE“RELEASEES” NAMED BELOW: there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not

readily foreseeable at this time: and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES,COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the activity.


  1. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the 100% RAW Powerlifting Federation, Inc., Paul Bossi, Jeremey Meyer, Holiday Inn @ Ameristar and related affiliated and subsidiary companies of each, as well as the officers, directors, agents, employees and assigns of each, coaches, officials, administrators, members, volunteers, participants, sponsors, advertisers, and if applicable, owners and lessors of premises on which the activity takes place, and any other party indemnified and held harmless by 100% RAW POWERLIFTING FEDERATION, INC., (each considered one of the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSES, OR


DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, NEGLIGENT SECURITY, TRAVEL, AND RECREATIONAL OPERATIONS AND ACTIVITIES; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Release’s, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expense, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.


  1. Drug Testing Statement, Agreement, & Release of Liability

I give my word as an athlete that I have not utilized any type of strength-including chemicals (anabolic steroids, growth hormone, etc.) for

the past three years ( March 2014 to March 2017)

In consideration of the acceptance of this entry, I agree to any test method deemed necessary by the meet director(s) and that the results of said testing method which the meet director and/or sponsors of this meet use to detect the presence of the strength inducing drugs may be released to any third party (ies) and I generally and specifically waive any right to privacy if any, related there to.


I hereby waive and release, intending to be legally bound for myself, my executors, administrators, and heirs, all rights and claims for damages I may have against 100% RAW Powerlifting Federation, Inc., Paul Bossi, Jeremey Meyer, Holiday Inn @ Ameristar and all parties associated with the 2017 Midwest Open as a result for testing positive for banned substances and the utilization of strength-inducing chemicals. I give permission to post my name and make it public if I test positive.

My entry into the 2017 Midwest Open constitutes my consent to the testing procedures; and, if any such results test positive, I understand that I shall be disqualified from the pertinent competition and suspended from the federation for a 2 year term.


I have read this agreement, fully understand its terms, understand that i have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, not withstanding, shall continue in full force and effect.

Electronic Signature of participant, if over 18.
Parent / Guardian Name:
Parent / Guardian Address:
Word Verification: