NGA Purebody Nutrition Extravaganza

Bodybuilding, Bikini & Figure Championships

Saturday, July 21, 2012

Amateur NGA Entry Form

ELIGIBLE:               Open to all natural amateur athletes who hold a current NGA card or may obtain membership on day of testing (cash only) for $35.00.  All classes are required to take a seven year drug-free polygraph.

PLACE:                   Caldwell Auditorium 300 S. College Ave Tyler, TX, (There is a $5 parking charge)

MEETING:               This is a mandatory meeting by the NGA, Friday July 20 at ________

TIME:                      PREJUDGING: 10:00 am (SHARP)

EVENING: SHOWTIME 6:00 PM - DOORS OPEN: 5:30 PM

MUSIC:                    Bodybuilding contestants must bring a CD with one track of 60sec music.

                               If the CD does not play the DJ will play substituted music.

ENTRY FEE:            $50.00 TO ALL CONTESTANTS/$25.00 TO CROSSOVER

                               Make checks or Money Orders payable to: Purebody Nutrition. Entry fees are non refundable. 

                               Entry forms will not be accepted without payment.  After July 6, 2012 Entry Fee is $75, no crossovers.

                               No Entries after July 11, 2012.

TESTING:                 All NGA athletes are required to take a seven year drug free polygraph test, scheduled on July 20

                                Testing fee is $45 and is payable in cash only to the polygraph technician on day of testing.

INFO:                       If you have any questions, Call Alicia Burgin 903-939-9232 begin_of_the_skype_highlighting            903-939-9232      end_of_the_skype_highlighting

SEND CHECK/ MONEY ORDER/ ENTRY FROM:  PureBody Nutrition, Alicia Burgin, 6747 S. Broadway, Tyler, TX 75703

Tickets:                  Prejudging:  $10 General Admission; $25 Reserved

                  Finals:  $10 in advance or $15 at the door for General Admission.  $30 Reserved.

                 Reserved Combo: (Prejudging and Finals):  $45

      Children under 10 accompanied by adult FREE (must have a free child ticket)

Contest Hotel:     to be announced                 

NGA PureBody Nutrition Extravaganza 2012

Amateur Bodybuilding, Figure and Bikini

NOVICE Bodybuilding           (   )  MEN                                              

                                                          (   )   LIGHTWEIGHT - TO 156 1/4 LBS.

                                                          (   )   MIDDLEWEIGHT - OVER 156 1/4 TO 172 1/4 LBS.

                                                          (   )   LIGHTHEAVYWEIGHT - OVER 172 1/4 TO 189 1/4 LBS.

                                                          (   )   HEAVYWEIGHT -  OVER 189 1/4 LBS.

                                                          (  )    Teen (18 and under)          

                                                    (   )  WOMEN

                                                          (   )   LIGHTWEIGHT - TO 112 1/4 LBS.

                                                          (   )   MIDDLEWEIGHT - OVER 112 1/4 TO 122 1/4 LBS.

                                                          (   )   HEAVYWEIGHT - OVER 122 1/4 LBS.

                                                          (  )    Teen (18 and under)

MENS' OPEN Bodybuilding        (   )   LIGHTWEIGHT - TO 156 1/4 LBS.

Pro Qualifier                                   (   )   MIDDLEWEIGHT - OVER 156 1/4 TO 172 1/4 LBS.

                                                          (   )   LIGHTHEAVYWEIGHT - OVER 172 1/4 TO 189 1/4 LBS.

                                                          (   )   HEAVYWEIGHT -  OVER 189 1/4 LBS.

WOMENS' OPEN Bodybuilding                          (   )   LIGHTWEIGHT - TO 112 1/4 LBS.

Pro Qualifier                                                             (   )   MIDDLEWEIGHT - OVER 112 1/4 TO 122 1/4 LBS.

                                                                                    (   )   HEAVYWEIGHT - OVER 122 1/4 LBS.

MEN MASTERS Bodybuilding PRO QUALIFIER              (   )   40-49             (   )   50-59 Grandmaster   (   )   60+ Great Grandmaster

(if there are not enough contestants this will only be 40+)

WOMEN MASTERS Bodybuilding PRO QUALIFIER      (     )  Must be able to prove age 40 and over

WOMEN FIGURE Novice       (   )  Height:______________ (depending on how many entries on height class divisions)

WOMEN FIGURE PRO QUALIFIER          (   )  Height:______________ (depending on how many entries on height class divisions)

WOMEN BIKINI                        (  )   Height:______________ (depending on how many entries on height class divisions)

 NAME_____________________________________________ AGE__________ DATE OF BIRTH________________________________

ADDRESS_________________________________________ CITY__________________ STATE __________   ZIP_________________

E-MAIL__________________________________________________________________________________________

Cell Phone_______________________                                                                                         

 WAIVER: By your accepting my application to the 2012 NGA Purebody Nutrition Extravaganza, along with my non-refundable entry fee, I herby intend to be legally bound for myself, my heirs, executors and administrators,.  I waive and release any and all rights and claims for damages I may have against PureBody Nutrition, Will and Alicia Burgin, all sponsers, Caldwell Auditorium, The National Gym Association (NGA), agents and representatives for any and all injuries and or losses suffered by me as a result of my participation and or attendance and traveling to the 2012 NGA Purebody Nutrition Extravaganza July 21 2012.  These damages include, but are not limited to, published photographs that I may find to be unattractive or editorial which I may construe as being misrepresentatice.  I also grant 2012 NGA Purebody Nutrition Extravaganza, promoter Will and Alicia Burgin , permission to use photos, video or any likeness of myself to promote any future contests and Purebody Nutrition, videos, magazines or any other media involved with future and present contest for the purpose of promotion and /or sales of these media, without any compensation to myself, as condition of my entering the event. I also agree, by my own free will and without duress, to take a polygraph test and submit a urine sample.  I also agree to the outcome of the test results from the polygraph examiner and urinalyses center.  I will abide by all NGA rules and show good sportsmanship.  By signing and submission of this form I am stating that I am at least 7 years drug free and will abide by the NGA drug test policies and procedures.

 SIGNATURE_______________________________________________________________________________   DATE ____________________________

SIGNATURE  OF  PARENT  OR  GUARDIAN (If  under  18)__________________________________________  DATE ____________________________

 RULINGS

   A.        The definition and rulings of a novice are:

             1.         a competitor that has not placed in the top 3 in an open division of any organization;

             2.         a competitor that has not won 1st place in a novice division of any organization;

             3.         a novice competitor cannot crossover to the open division and vice versa; and

            4.         a master  can crossover into the novice or open division, but not both.

 B.        This show entitles only the overall class winners in the open division to turn pro (5 competitors equal a valid class).

   C.        Promoters have the option of canceling any class for an insufficient amount of competitors;

   D.        Promoters have the option of splitting a division that has a total of 10 or more athletes.  For example, if the teen division has 10 competitors, the Promoter can divide this class into two calling them "Teen "A" and "B".  This division should be worked out as evenly as possible either by age, weight, or height.  Promoters should look at all entry forms and decide which way to go.  It is the Promoter's option whether or not to do an overall of "Teen A" and "Teen B".

   E.        All athletes will be introduced to the audience at the evening show.  The promoter will have the option of having only the top five in each class pose in the evening show due to the amount of competitiors.