2024 Shenandoah Online SHENANDOAH OPEN Powerlifting & Single Lift ChampionshipsBench Press- Deadlift –Strict Curl-Push-Pull-IronmanThe Gym109 N Main Street ** Woodstock,VA 22664Meet Director: John Shifflett 186 Happy Hollow Road ** valifting@aol.comDate: Saturday, August 24, 2024 Venue:The Gym Woodstock, VirginiaTime: Doors open to public – 8:00 amWeigh-in: Friday , 5-6 pm - Professional DigitalScale Saturday by appointment Technical Meeting: Saturday, 8:00 am 100% RAW Web Site -http://rawpowerlifting.comIdentification:PhotoIdentification is necessary for security, to verify every lifter’s entryinformation, and to help validate drug testing. Acceptable identificationincludes driver’s license, state ID, school ID, passport. Work ID badges andrecreational/social club ID’s are not acceptable.Federation Membership Fee: Current federation membership is required. Cards MUST be purchasedonline https://rawpowerlifting.com/join-us/registration/Entry Fee:Allfees should be paid by July 29, 2024Awards: Top Five lifters in all age and weight classes inboth male and femaleDrug Testing: This will be a drug tested event. You are responsiblefor what you put in your body. 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. *PowerliftingBench PressDeadliftPush-PullIronman (Bench/Strict Curl)Strict Curl Event Selection: (Select as many as you would like.) *Powerlifting (First 20 entries) $90Bench Press $90Deadlift $90Push-Pull (Bench and Deadlift for a total) $90Ironman (Strict curl and Bench for a total) $90Strict Curl (Saturday @8:30 am) $90 Additional Events - $40/each Crossover Age/Open - $40 You can select multiple options.Age / Open - $401 Additional Event - $802 Additional Events - $1203 Additional Events - $1804 Additional Events - $220 TotalATHLETES MUST COMPLETE AND SIGN THE RAWRELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY, AND THE PARENTALCONSENT 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, andassigned heirs and next to kin:1. ACKNOWLEDGES,agree,and represent that I understand the nature of the activity and that I amqualified, in good health and in proper physical condition to participate insuch activity. I further agree andwarrant that if at any time I believe conditions to be unsafe; I willimmediately discontinue further participation 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, Inc., John Shifflett LLC, JohnShifflett, William Thacker, The Gym or related affiliated andsubsidiary 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 andlessors of premises on which the activity takes place, and any other partyindemnified and held harmless by 100%RAW POWERLIFTING FEDERATION, INC., (each considered one of the“RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSES, OR DAMAGES ONMY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCEOF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS,NEGLIGENT SECURITY, TRAVEL, AND RECREATIONAL OPERATIONS AND ACTIVITIES; AND IFURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTIONOF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claimagainst any of the Release’s, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OFTHE RELEASEES from any litigation expense, attorney fees, loss, liability,damage, or cost which any may incur as the result of such claim.4. Drug Testing Statement, Agreement, & Release of LiabilityI give my word asan athlete that I have not utilized any type of strength-including chemicals(anabolic steroids, growth hormone, etc.) for the past three years (August 24, 2021 to August 24, 2024) Inconsideration of the acceptance of this entry, I agree to any test methoddeemed necessary by the meet director(s) and that the results of said testingmethod which the meet director and/or sponsors of this meet use to detect thepresence 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. Ihereby waive and release, intending to be legally bound for myself, myexecutors, administrators, and heirs, all rights and claims for damages I mayhave against 100% RAW PowerliftingFederation, Inc., John Shifflett LLC, John Shifflett, WilliamThacker, The Gym and all parties associated with the 2024 100% RAW Shenandoah Open CHAMPIONSHIPSas a result of testing positive for the utilization of strength-inducingchemicals. Should I fail the drug test, I agree to forfeit my award that I mayhave won. I agree that if I fail the drug test my name will appear on apublished list of suspended members. If the drug test to which I submit ispositive, then I waive any claim, action or cause for which legal relief isavailable. Myentry into the 2024 100% Raw Shenandoah Open Championships constitutes myconsent to the testing procedures; and, if any such results test positive, Iunderstand that I shall be disqualified from the pertinent competition andsuspended for lifetime by the federation.I Have Read This Agreement, Fully Understand ItsTerms, Understand That I Have Given Up Substantial Rights By Signing It AndHave Signed It Freely And Without Any Inducement Or Assurance Of Any Nature AndIntend It To Be A Complete And Unconditional Release Of All Liability To TheGreatest Extent Allowed By Law And Agree That If Any Portion Of This AgreementIs Held To Be Invalid, The Balance, Not Withstanding, Shall Continue In FullForce 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