All Rights Reserved
Created and Maintained by Stefan Meholick
Northern California Open Entry Form  
THE DEADLINE FOR REGISTRATION IS MAY 9, 2010.  
NO LATE OR MAIL-IN ENTRIES WILL BE ACCEPTED.
Full Name:
Date:
Full Name of Parent
(if under 18):
*
Do you agree to the
terms outlined above?
(write "YES" if you do)
*I agree by signing this form for the 2010 Northern California Open
(USAW/PWA #38-10-05), to abide by all of the rules of USA Weightlifting
(USAW) and the Pacific Weightlifting Association (PWA).
Please Fill Out ALL of the Following Questions and Press "Submit"
Your name:
Your phone number:
(Area code first)
Address:
City:
Zip Code:
Your email address:
Bodyweight Class
(In KG):
Year of Birth:
Type "Male" or
"Female":
Entry Total (In KG):
T-Shirt Size (SM-M-L
or XL):
Current USAW card
number:
USAW card
expiration date:
USAW Club:
YOU MUST HAVE A CURRENT USA WEIGHTLIFTING MEMBERSHIP TO
COMPLETE THIS ENTRY.
Name on Credit
Card:
Type of Card (TYPE
VISA or
MASTERCARD):
Credit Card Number:
Card Expiration Date:
Card Security CCV
Number (on BACK of
Card):
Amount to Charge   
( EXAMPLE 45.00):
$45.00 FOR SENIORS AND MASTERS / $25.00 FOR JUNIORS
Entry Type: (TYPE
"STANDARD"
"JUNIORS" or
"MASTERS")
Questions or
Comments:
I agree by signing this entry for the 2010 Northern California Open to abide by all rules of USA
Weightlifting (USAW) and the Pacific Weightlifting Association (PWA). I will not hold USAW, the
PWA, the Officials and Organizers of this event, or TJ’s Gym (to include TJ's Gym, LLC and TJ's
Gym Novato, LLC) responsible for any injuries sustained while competing in, or traveling to and
from this event.
I (and my parent or guardian if I am a minor) agree to be filmed and photographed at the venue;
to have my name, interviews, biographical information, photographs, and videos of my
weightlifting performance taken and used by the organizer; and I grant the organizer the right to
record and make use of these, and to authorize others to do so, in promoting the competition
and the success of the weightlifting team on which I compete, to promote the sport of
Weightlifting, and to fund the activities of TJ’s Gym and the PWA.
for Seniors and Masters - $25.00 for Juniors by May 9, 2010.