Please type or print clearly, and mail (postmarked by Saturday, June 13, 2009) the following “Acadiana’s Strongest Gym” competition registration form to Pinnacle Performance, P.O. Box 143, Charenton, LA 70523.

Each team member must submit this form!

Name
Address
Phone
Email
Age	(you must be 18+ years of age to enter)
T-Shirt Size

What is the name of the gym your team is representing? ________________________________

Estimate your opening attempt: Bench Press _______ pounds, Curl _______ pounds

Please check one.

o A nonrefundable registration fee in the amount of $100 per 3 to 5 man team has been made payable to Pinnacle Performance, and remitted to P.O. Box 143, Charenton, LA 70523.

o A nonrefundable registration fee in the amount of $100 per 3 to 5 man team has been made via PayPal.

In consideration of the acceptance of this entry thereby for myself, my heirs, executors, and administrators waive and release any and all claims and damages I may have against Pinnacle Performance Physique and Strength Sport Enterprises, Inc., The Gym, their representatives, successors, and assigns for any and all injuries or bodily harm that I may suffer while competing in the “Acadiana’s Strongest Gym” competition. I attest and verify that I am at least 18 years of age, and I have full knowledge of the risks involved with my participation of this event.

Signature _________________________ Date _______________