Mid-Illinois Championship - Contest Entry Form

Mid-Illinois Bodybuilding, and Figure Championship

Name:
Email Address:
Phone Number:
Address:
City
State:
Zip Code
NPC Card #:
Division (See Class Page):
Credit Card Type (Visa/Mastercard):
Credit Card Number ($70.00 per entry):
Credit Card Expiration Date :
Terms: Please Read Carefully and Enter Name In Box As Signature In consideration of accepting this entry, I hereby, intending to be legally bound for myself, my heirs, executors and administrators, 1) Waive any and all rights and claims for damages I may have against Jeff and Ann Johnson, the National Physique Committee of the U.S.A, INC. (the "NPC"), the Illinois District of the NPC, O.T.H.S., or the agents, employees, representatives or assigns of any of the foregoing persons or entities for any and all injuries or damages I may incur while traveling to and from, or participating in the competition, and 2) Certify that I am an amateur in good standing and am eligble to compete in this competition in the Division(s) in which I have entered. I further agree to abide by all decisions of the NPC and declare that all the information contained herein is to the best of my knowledge, true, correct, and complete. (If competitor is a minor under 18 years of age this blank must be signed by parent or legal guardian.) Enter Your Name in the Box Below as Signature in Agreement of Terms Stated Above: