2024 Patriots Online 2024 PATRIOTS OPEN BENCH PRESS/DEADLIFT/STRICT CURL/IRONMAN/PUSH-PULLRonRosner Family YMCA5700Smith Station RoadFredericksburg,VA 22407Meet Director: JohnShiffletthttps://family-ymca.org/find-a-y/ron-rosner/Host City Fredericksburg, VA22405Date:Saturday, September 14, 2024 Time: Doors open – 8.00AMWeigh-in: Friday 5:00-6:00PM Saturday by appointment onlyLifting: 9:00 AMTechnical Meeting: Saturday8:15 AMScales:Digital scaleArrivals/Transportation: For the best directions, please go to www.mapquest.com. Identification:PhotoIdentification is necessary for security, to verify every lifter’s entryinformation, and to help validate drug testing. Acceptable identificationincludes a driver’s license, state ID, school ID, and passport. Work ID badgesand recreational/social club IDs are not acceptable. Federation Membership Fee: Currentfederation membership is required. Applicants should submit a completed membershipform along with payment prior to weigh-ins. Cards must be ordered onlinehttps://rawpowerlifting.com/join-us/registration/EntryFee:All fees should be paid byAugust 17, 2024Awards: Top five placesfor each event in each age/weight class.Correspondence (emailpreferred): Correspondenceregarding 100% Raw Powerlifting Federation Virginia events should be sentto valifting@aol.com or US mail to John Shifflett 186 Happy Hollow Road Ruckersville, VA 22968. Lifter Name*FirstLast Lifter DOB*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 20192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Lifter Gender:*MaleFemale Lifter Email:* Lifter Phone* Lifter RAW Member #* Membership Expiration Date (use mm/dd/yyyy or "Lifetime")* Lifter Address Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Select Weight Class:*Select value66778897105114123132148165181198198+ (Women ONLY)220 (Men ONLY)242 (Men ONLY)275 (Men ONLY)308 (Men ONLY)SHW (Men ONLY) Lifter Bodyweight (pounds)* Divisions- Select All that Apply*OpenYouth 11-underTeen: 12-13Teen: 14-15Teen: 16-17Teen: 18-19Junior: 20-24SubMaster 35-39Masters 40-44Masters 45-49Masters 50-54Masters 55- 59Master 60-64Masters 65-69Masters 70-74Masters 75-79Masters 80+P/F/M Events to Compete in- Select as many as you wish. Powerlifting (First 20 to enter) All events $90 Add any additional event for just $50 more. *Ironman (Bench/Strict Curl)Bench PressDeadliftStrict CurlPush-Pull Event Selection: (Select as many as you would like.) *Ironman (Strict curl and Bench for a total) $90Bench Press $90Deadlift $90Strict Curl $90Push-Pull (Bench and Deadlift for a total) $90 Additional Events - $50/each Crossover Age/Open - $50 You can select multiple options.Age / Open - $501 Additional Event - $1002 Additional Events - $1503 Additional Events - $2004 Additional Events - $250 TotalATHLETES MUST COMPLETEAND 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 toparticipate in a 100% RAW (“activity”) I, my personal representatives, assignedheirs and next to kin:1. ACKNOWLEDGES, agree, and represent thatI understand the nature of the activity and that I am qualified, in good healthand in proper physical condition to participate in such activity. I further agree and warrant that if at anytime I believe conditions to be unsafe; I will immediately discontinue furtherparticipation in the activity.2. FULLY UNDERSTAND that: (a) ATHLETICACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDINGPERMANENT DISABILITY, PARALYSIS, ANDDEATH(“Risks”): (b) these Risks anddangers may be caused by my own actions or in actions of others participatingin the activity, the condition in which the activity takes place, or THE NEGLIGENCE OF THE “RELEASEES” NAMEDBELOW: there may be OTHER RISKS ANDSOCIAL AND ECONOMIC LOSSES either not known to me or not readilyforeseeable at this time: and I FULLY ACCEPT AND ASSUME ALL SUCH RISKSAND ALLRESPONSIBILITY FOR LOSSES,COSTS, AND DAMAGES I incur as a result of my participation or that of theminor in the activity.3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOTTO SUE the 100% RAW Powerlifting Federation, John Shifflett LLC, PaulBossi, John Shifflett, William Thacker, Ron Rosner Family YMCA, relatedaffiliated 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, andif applicable, owners and lessors of premises on which the activity takesplace, and any other party indemnified and held harmless by 100% RAWPOWERLIFTING, (each considered one of the “RELEASEES”herein) FROM ALL LIABILITY, CLAIMS,DEMANDS, LOSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED INWHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDINGNEGLIGENT RESCUE OPERATIONS, NEGLIGENT SECURITY, TRAVEL, ANDRECREATIONAL OPERATIONS AND ACTIVITIES; ANDI FURTHER AGREE that if, despite this RELEASEAND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITYAGREEMENT I, or anyone on my behalf,makes a claim against any of the Release’s, I WILLINDEMNIFY, SAVE, ANDHOLD HARMLESS EACH OF THE RELEASEES from any litigation expense, attorneyfees, loss, liability, damage, or cost which any may incur as the result ofsuch claim.4. Drug Testing Statement, Agreement, & Release of Liability I give my word as an athletethat I have not utilized any type of strength-including chemicals (anabolicsteroids, growth hormone, etc.) for the past three years (September 14, 2021to September 14 , 2024) In consideration of theacceptance of this entry, I agree to any test method deemed necessary by themeet director(s) and that the results of said testing method which the meetdirector and/or sponsors of this meet use to detect the presence of thestrength inducing drugs may be released to any third party(ies) and I generallyand specifically waive any right to privacy if any, related thereto. I hereby waive and release,intending to be legally bound for myself, my executors, administrators, andheirs, all rights and claims for damages I may have against 100% Raw PowerliftingInc, John Shifflett LLC, Paul Bossi, JohnShifflett, William Thacker, Ron Rosner Family YMCA and all parties associatedwith the ”2024 100% RAW Patriots Open Bench Press, Deadlift, Strict Curl asa result of testing positive for the utilization of strength-inducingchemicals.Myentry into the ”2024 100% RAW Patriots Open, ” constitutes my consent tothe testing procedures; and, if any such results test positive, I understandthat I shall be disqualified from the pertinent competition and suspended for aperiod to be fixed by the meet director(s).IHAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVEGIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUTANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE ANDUNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAWAND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THEBALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. Participant Name:*FirstLast Date Signed*Minor'sRELEASEAND I, THEMINOR'S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF ATHLETICACTIVITIES AND THE MINOR'S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TOBE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATEIN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREETO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE'S FROM ALL LIABILITY,CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR'S ACCOUNT CAUSED OR ALLEGED TOBE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OROTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF,DESPITE THIS RELEASE. I THE MINOR OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIMAGAINST ANY OF THE RELEASEES NAME ABOVE, I WILL INDEMNIFY, SAVE, AND HOLDHARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES,LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM. Guardian Name:FirstLast Guardian Phone Guardian Email: Word VerificationSubmitReset