BENCHMANIA 3 REGISTRATION

BENCHMANIA 3 REGISTRATION

JANUARY 23RD 2027
Name

First NameLast Name
Contact Details

EmailPhone Number
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Gender
Category
Division
Weight Class
T-Shirt Size
Emergency Contact

NamePhone Number
I understand that this is a no refund event, and my entry may not be transferred to another person if I am no longer able to compete
I understand that my entry fee must be paid within 48 hours of submitting this form, otherwise my entry may not be accepted
I understand that the organiser holds no responsibility or liability should I sustain an injury whilst taking part in this event
FOR COMPETITORS UNDER THE AGE OF 18
I, parent/guardian, hereby give my consent for my son/daughter to participate in Benchmania, and they will have a parent/guardian present on the day of competition
ENTRY FEE: $110.00 (includes competition t-shirt)

PAYMENT DETAILS:

KAYLA WATENE
01-0461-0133332-30

Particulars: B3

Reference: Name
Signature
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