2021 MR AMERICA AAU USA POWERLIFTING CHAMPIONSHIP & NATIONAL SINGLE LIFT CHAMPIONSHIP
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Age
*
Birthday
*
-
Month
-
Day
Year
Date
Height
*
Weight
*
A.A.U. #
*
Social Media Contact #1
Social Media Contact #2
Gender
*
Male
Female
Men Weight Classes
114
123
132
148
165
181
198
220
242
275
308
SHW
Not Applicable
Women Weight Classes
97
105
114
123
132
148
165
181
198
SHW
Not Applicable
Registration
*
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( X )
Primary Division Selection
$
80.00
Divisions
Open
Teen
Youth
Junior
Submaster
Master
Mil/Law/Fire
Lifetime
Lifetime Masters
Disabled
High School
Cross Over
$
40.00
Cross Over
Open
Teen
Youth
Junior
Submaster
Master
Mil/Law/Fire
Lifetime
Lifetime Masters
Disabled
High School
Cross Over 2
$
40.00
Cross Over
Open
Teen
Youth
Junior
Submaster
Master
Mil/Law/Fire
Lifetime
Lifetime Masters
Disabled
High School
National Single Lift Championships
$
Free
Single Lift Championships
Quantity
Price
Bench
0
1
$
40.00
Deadlift
0
1
$
40.00
Push/Pull
0
1
$
40.00
Item subtotal:
$
0.00
Submit
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