Order Custom Awards Online 2024 VIRGINIA OPEN POWERLIFTINGBench Press- Deadlift-Strict Curl - Push-Pull - Ironman(Strict Curl and Bench Press for a total)The Gym ** 109 N Main Street ** Woodstock, VA 22664Meet Director: John Shifflett 186 Happy Hollow Road Ruckersville, VA 22968valifting@aol.comDate: Saturday, January 20, 2024Venue: The GymTime: Doors open to the public – 8:00 am,Weigh-in: Friday, 5-6 pm - Professional Digital Scale Saturday By appointment onlyTechnical Meeting: Saturday, 8:00 am 100% RAW Web Site -http://rawpowerlifting.comIdentification: Photo Identification is necessary for security, to verify every lifter’s entry information, and to help validate drug testing. Acceptable identification includes a driver’s license, state ID, school ID, and passport. Work ID badges and recreational/social club IDs are not acceptable.Federation Membership Fee: Current federation membership is required. Cards MUST be purchased onlinehttps://rawpowerlifting.com/join-us/registration/Entry Fee: All fees should be paid by January 3, 2024$50 per Crossover to Open or age divisions.Awards: Top Five lifters in all age and weight classes in both male and femaleDrug Testing: This will be a drug-testing event. You are responsible for 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. The first event is $90, additional ones are $50.*PowerliftingBench PressDeadliftStrict Curl (Friday night @ 7pm)Push-PullIronman (Bench/Strict Curl) Event Selection: (Select as many as you would like.) *1 Event-$902 Events-$1403 Events-$1904 Events - $240 CROSSOVERS: Open and AGE - $50*Age and Open 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 (January 20, 2021 to January 20, 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, William Thacker, The Gymand all parties associated with the 2024100% RAW Virginia Open as a result of testing positive for theutilization of strength-inducing chemicals. Should I fail the drug test, Iagree to forfeit my award that I may have won. I agree that if I fail the drugtest my name will appear on a published list of suspended members. If the drugtest to which I submit is positive, then I waive any claim, action or cause forwhich legal relief is available. Myentry into the 2024100%Raw Virginia 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. 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