Lexen Summer Slam
2012 RPS Ohio State Powerlfiting Championships

June 23, 2012

Ultimate Sports Center
1200 Steelwood Rd., Suite B
Columbus, OH 43212
Google Maps

2012 Lexen Summer Slam Entry Form

Online Entry Prices
3 Lift – $104.00 • + crossover $140.00
2 Lift – $75.00 • + crossover $114.00
Single Lift – 52.00 • + crossover $88.00

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Entry Fees  Full Power $104.00 USD Full Power + 1 Crossover $140.00 USD 2 Lift (push/pull) $75.00 USD 2 Lift (push/pull) + 1 Crossover $114.00 USD Single Lift $52.00 USD Single Lift + 1 Crossover $88.00 USD

Competitor’s Name

Street Address

City, State, Zip

Phone E-mail Address

Age Birthdate

Meet  6/23 Lexen Summer Slam

Events (*adding additional events is the same as additional divisions) Event 1  Full Power Ironman (push/pull) Squat Only Bench Only Deadlift Only Event 2*  —— Full Power Ironman (push/pull) Squat Only Bench Only Deadlift Only Event 3*  —— Full Power Ironman (push/pull) Squat Only Bench Only Deadlift Only Event 4*  —— Full Power Ironman (push/pull) Squat Only Bench Only Deadlift Only

Weight Class  97 (women only) 105 (women only) 114 123 132 148 165 181 198 220 242 (men only) 275 (men only) 308 (men only) SHW Sex Male Female

Divisions: Multi-Ply, Single-Ply, Raw Classic (no knee wraps), Raw Moden (w/ knee wraps) Division 1 Multi-Ply Single-Ply Raw Classic Raw Modern Division 2 ———- Multi-Ply Single-Ply Raw Classic Raw Modern Division 3 ———- Multi-Ply Single-Ply Raw Classic Raw Modern Division 4 ———- Multi-Ply Single-Ply Raw Classic Raw Modern

Class: Amateur, Professional, Elite*, Police Pro, Police Am, Military Pro, Military Am (*Elite $100 Mandatory Test Fee to be paid prior to start of meet) Class 1 AM (drug tested) Pro (non-tested) Elite Police Pro Police AM Military Pro Military AM Class 2 AM (drug tested) Pro (non-tested) Elite Police Pro Police AM Military Pro Military AM ——— Class 3 AM (drug tested) Pro (non-tested) Elite Police Pro Police AM Military Pro Military AM ——— Class 4 AM (drug tested) Pro (non-tested) Elite Police Pro Police AM Military Pro Military AM ———

Age Divisions: Open, Teen, Junior (20-23), Submaster (33-39), Master Age Division 1 Teen Junior Open Submaster Master Age Division 2 ——– Teen Junior Open Submaster Master

Become a Sponsor

Are you interested in becoming a sponsor for one of the LexenXtreme Powerlifting meets? Please see the LexenXtreme Sponsorship Form.