Strongman Entry Form

 

Saturday September 9th 2017 at 9:00 am

 

Enter ONLINE:

This is a 2 step process
1. Submit Entry (below)
2. Pay PBF Strongman Entry Fee & Reserve T-Shirt size via PayPal (which follows)
3. Active United States Strongman (USS) membership required/may purchase at event

 

STEP ONE

Fill out the following online form (again by clicking "submit" you accept the terms)


Fill in all information *REQUIRED:

Name: *

Address:*

City: * State: * Zip: *

Age: * Date of Birth: *

Phone: * Email: *

 

Division & Class: * Height: ft in*

Gym: *

In consideration of your acceptance of this entry, I hereby, for myself, my heirs, executors and administrators, and my assignees, waive and release all rights and damages I may have against United States Strongman, Inc., Willie Wessels,any and all sponsors of the event, their representatives and assigns, for any and all injuries incurred by me in conjunction with these championships and in traveling to and from the event. And in further consideration of permission being granted to me to participate in the United States Strongman, Inc. CONTEST and its related events, I hereby grant United States Strongman, Inc., and/or any other approved video or entertainment organization and all of their agents, successors, licensees and assigns, the right to photograph or otherwise reproduce (whether by film, tape, still photography or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit, and/or otherwise exploit any and all media, including without limitation, by means of still photography, motion pictures, radio, television, television motion pictures, video, printing or any other medium now known or hereafter devised, including with respect also to any merchandising, advertising and/or publicity, and the right to use my name and information about me in any connection with any of the foregoing. The rights granted by me hereunder are granted for the entire universe and shall endure in perpetuity and no further compensation shall be payable to me at anytime in connection therewith. Nothing contained herein shall be deemed to obligate United States Strongman, Inc., and/or any other approved video or entertainment organization, to photograph or otherwise reproduce my voice, appearance or name, or to make use of any rights granted herein. I also understand that the aforementioned rights may be reassigned at any time without further consent. I understand that United States Strongman, Inc. and/or any other approved video or entertainment organization, are videotaping and photographing the Event in express reliance upon the foregoing, and I represent and agree that I am free to grant the rights granted to United States Strongman, Inc.. and/or any other approved video or entertainment organization hereunder. Therefore I affix my signature below:

 

Signature: *

(as digital signature, please type your full legal name)


(The page that follows will permit payment and T-Shirt reservation)

OR Pay by mail/check: Fill out this form, print page instead, sign in ink, include check payable to Warren County Prime Beef Festival and mail both to:

PBF Strongman % Monmouth Area Chamber
89 Public Square
Monmouth IL 61462


 


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