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application. SPECIAL NOTICE : This contest is an OFFICIAL NATIONAL QUALIFIER for all national events in 2013 & 2014. SANCTION : This contest is sanctioned by the National Physique Committee of the USA Inc. (NPC). Sanction #12028 ELIGIBILITY : This contest is Open to all male and female athletes in the U.S. Contestants must be a member of the NPC and membership cards will be available for purchase at the event: 2013 fee: $100.00. Those in the Teen and Masters, must provide proof of age at the check in. AWARDS Impressive sculptures by Niels Andersen will be the awards. Every competitor will receive a FREE So. States t-shirt, Goody Bag and copy of the official souvenir program. BODYBUILDING
REGISTRATION/CHECK IN BODYBUILDING & WOMEN’S PHYSIQUE MANDATORY CHECK IN: Friday, July 12, 2013 – 3:00pm-7:00pm, War Memorial Auditorium, Warm-Up area. This is the only weigh in for bodybuilding and women’s physique. There is not an early and late weigh-in this year. This will help expedite the starting of the prejudging at 9:00am on Saturday morning. In case of emergency or hardship, call the promoter for a late weigh-in on: Saturday, July 13, 2013 – 8:00am-9:00am War Memorial Auditorium ATHLETE MEETING AT 9:30AM - PREJUDING STARTS 9:00AM – EVENING SHOW AT 6:00PM
GENERAL INFORMATION TANNING: On-Site/Backstage Tanning will be provided by Hot Spot of Sarasota. Tanning will be available to the competitors on Thursday July 11th at the Gallery One - Ft. Lauderdale Doubletree Suites Hotel (contest host hotel),and then Friday, July 12th, and Saturday, July 13th, backstage at the War Memorial Auditorium. To make an appointment Call ALISA HOSTETTLER @ 727-403-5180 or e-mail: Tan@HotSpotSarasota.com Please enter me in the following contest (check appropriate contest): ENTRY FEE: $60.00
Note: All contestants will be officially weighed in (see
times above) and should have their competition suits on or available for approval. STREET ADDRESS: _______________________________________ APT. #: ________
TELEPHONE (_____) _________________________________________ TEAM/CLUB/GYM AFFILIATION: _______________________________________________________
PAST CONTESTS ENTERED & RESULTS: __________________________________________________ In consideration of your accepting this entry, I, hereby intending to be legally bound for myself, my heirs, executors or administrators, waive any and all right and claim for damages I may have against the National Physique Committee of the USA Inc. (NPC), Peter W. Potter, USA Sports Promotions of FL Inc., Maria Bellando, Manuel Mair, War Memorial Auditorium, the sponsors and them or their agents, representatives and assignees for any and all injuries suffered by me at said NPC Southern States Championships and in travel to and from said contest. I hereby grant the NPC and/or any other NPC approved video or entertainment organization and all of their agents, successors, licensees and assigns, the right to photograph or otherwise reproduce (whether by film, tape, still photography or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit and/or otherwise exploit any and all media, including without limitation, by means of still photography, motion pictures, radio, television, video, printing or any other medium now known or hereafter devised, including with respect also to any merchandising, advertising and/or publicity, and the right to use my name and information about me in any connection with any of the foregoing. Those staying at the host hotel, by signing this agreement, agree to be responsible for any damage to the hotel room as a result of any body color, oils, spray tan or any other damage to hotel bedding, towels, carpet, drapes, walls doors or any other furnishings, In consideration of being allowed to participate in any way in the 2013 NPC SOUTHERN STATES BODYBUILDING & WOMEN'S PHYSIQUE CHAMPIONSHIPS promoted by USA Sports Promotions of FL, Inc. and sanctioned by the National Physique Committee of the USA, Inc. (“NPC”), its related events and activities, I, Please print name_____________________________________________________), the undersigned, acknowledge, appreciate and agree that: The risk of injury from the activities involved in this Event is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I KNOWLINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE PROMOTER AND/OR THE NPC or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation, if, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Promoter immediately; and,I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE PROMOTER AND THE NPC and each of their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY DISABILITY, DEATH, or loss or damage to person or property associated with my presence at or participation in or in traveling to and from the Event, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. The undersigned further consents and agrees that the undersigned will comply with all rules and regulations of the Gallery One - Ft. Lauderdale Doubletree Suites Hotel including any rules or regulations prohibiting cooking or food preparation in the hotel rooms. The undersigned further agrees that the undersigned will indemnify and hold harmless the NPC and the Promoter from and against any damages caused by the undersigned to the Hotel or damages to a guest room or rooms occupied or registered to the undersigned. Finally, the undersigned acknowledges that the undersigned’s failure to comply with any rule or regulation of the Hotel or damage to any guest room occupied by or registered to the undersigned may result in disciplinary action against the undersigned including, but not limited to, suspension as a member of the NPC and/or competing in contests sanctioned by the NPC. And in further consideration of permission being granted to me to participate in the Event and its related events. I hereby grant the NPC, Promoter and/or any other NPC-approved video or entertainment organization and all of their agents, successors, licensees and assigns, the right to photograph or otherwise reproduce (whether by film, tape, still photography or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit, and/or otherwise exploit any and all media, including without limitation, by means of still photography, motion pictures, radio, television, television motion pictures, video, printing on digital or any other medium now known or hereafter devised, including with respect also to any merchandising, advertising and/or publicity, and the right to use my name and information about me in any connection with any of the foregoing. The rights granted by me hereunder are granted for the entire universe and shall endure in perpetuity and no further compensation shall be payable to me at any time in connection therewith. Nothing contained herein shall be deemed to obligate the NPC, Promoter, and/or any other NPC-approved video or entertainment organization, to photograph or otherwise reproduce my voice, appearance or name, or to make use of any rights granted herein. I also understand that the aforementioned rights may be reassigned at any time without further consent. I understand that the NPC, the Promoter and/or any NPC-approved video or entertainment organization, are videotaping and photographing the Event in express reliance upon the foregoing, and I represent and agree that I am free to grant the rights granted to the NPC, Promoter and/or any other NPC-approved video or entertainment organization hereunder. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. X________________________________________ Age:__________Date Signed:_________________ PARTICIPANTS SIGNATURE FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. X________________________________________ Age:__________Date Signed:_________________ PARTICIPANTS SIGNATURE SEND ALL ENTRIES & FEES TO:
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