2006 NPC Wheelchair Nationals Championships

OFFICAL ENTRY FORM-SHOW DATE: MARCH 18, 2006 All entries must be postmarked no later than February 15.2006 (Please Print Clearly)

Name_________________Age____Height____Weight____ Phone_______________Email___________________ Address______________________ Apt No ____City ________State __ Zip _______Province_________ Gym _____________________ NPC Card #: _________________

BODYBUILDING DIVISION (Please Check)

• Open Men_____
• Open Women____
• Master Men Over 40_______
• Novice______

Weight Class you intend to compete in (Please Check)

• Lightweight (up to 132)_____
• Middleweight (133 up to 150)_____
• Lt- Heavy (151 up to 163)_____
• Heavyweight (anything over 163)_____
• Class Of Champion (All Past NPC Overall Wheelchair Champions)_____
• Master Men Over 40_____
• Women (one class)_____
• Novice______ (never won a overall title)

  Note: All bodybuilding contestants will be officially weighed in and their exact weight class then assigned.

  I in consideration of your acceptance of this entry form and fee, I hereby waive and release all rights and claims for damages against the NPC, William T Dryer Auditorium, FRANK DALTO and their officials, agents, assigns, and associated bodies, by reason on injury or damages I might incur at or traveling to or from this competition. I further declare that all the information contained herein is, to the best of my knowledge, true correct, and complete. I agree to abide by all decisions of the NPC. And in further consideration of permission being granted to me to participate in this event, I hereby grant you, FRANK DALTO approved video or entertainment organizations, and all of their agent’s, successors, licenses and assigns the right to photograph or to other wise reproduce (whether by film, tape, still photography, or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit and/or other wise exploit any and all such reproductions containing my voice and/or appearance in any and all media, including without limitation, by means of still photography , motion pictures, radio, television, television motion pictures, video, printing, internet or any other medium now known or hereafter devised, including also with respect to any merchandising, advertising and/or publicity, and the rights to use my name and information about me in any connection with any of the forementioned media. The rights granted to 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. SIGNED X_________________________________________ If 18 or younger, signature or parent/guardian)X________________________________ IF YOU HAVE ANY QUESTION CONTACT:FRANK DALTO AT (561) 627-9638OR YOU CAN CONTACT:TONY HAWES AT (770) 971-2068 OR EMAIL:tonyhawes6@lhotmail.com

  Mail entries to Frank Dalto #2 Old Meadow Way Palm Beach Gardens, Fl 33418