Nomination Form

Preliminary: 31st October Final: 24th November Last day to cancel the booked hotel rooms: 1st December14
SUBRATA CLASSIC OPEN WORLD
An Open Invitation International Meet for Unequipped Powerlifting, Benchpress & Deadlift Championships
from16
th
December to 21
st
December,2014.
The preliminary and final nomination forms must be sent to:
Original: Meet Director: and Bhaskar Mitra, Hony. Genl. Secretary, Indian Powerlifting Federation
E-mail: indianpowerlifting@gmail.comMobilephone: +91-94307-20988, +91-98108-59374
Web Page : indianpowerliftingfederation.com
Correspondence: Bhaskar Mitra, e-mail : bhaskarkumarmitra@gmail.com
Accommodation transport: Bhaskar Mitra, e-mail : bhaskarkumarmitra@gmail.com
Copy: P.J. Joseph (pjjoseph_arjun@yahoo.co.in )
Submitted by National Powerlifting Federation/Association
Submitting officer: Title: Chairperson Date:
Teammanager :
Coach:
Referee 1: Cat: Available for categories:
Referee 2: Cat: Available for categories:
Referee 3: Cat: Available for categories:
Referee 4: Cat: Available for categories:
Nominations -- Mens Open
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Mens Junior
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Mens Sub-Junior
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Mens Masters 1
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Mens Masters 2
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Mens Masters 3
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Mens Masters 4
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Womens Open
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Womens Junior
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Womens Sub-Junior
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Womens Masters 1
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Womens Masters 2
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Nominations -- Womens Masters 3
Class Family Name First Name Birthday BP
Reserve lifters, max. 5 per team
Address for contact:
Name: Street: Zipcode:
City: Country: Phone:
Fax: E-Mail:
INDIAN POWERLIFTING FEDERATION
Bhaskar Mitra, E-mail: bhaskarkumarmitra@gmail.com
Phone: +91-94307-20988
Visa Support Form
Full names of athletes Birth Day Passport Number Expiration Date
Full names of coaches Birth Day Passport Number Expiration Date