NAME____________________________________AGE________________ STREET ADDRESS_____________________________________________ CITY/STATE/ZIP CODE_________________________________________ PHONE NUMBER_______________________________________________ E-MAIL________________________________________________________ TEAM________________________________________________________

In the space provided, list what you would like the announcer to say: __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ TRAINER___________________________________________________

In consideration of accepting this entry, I hereby, intending to be legally bound for myself, my heirs, executors and administrators,(i) Waive any and all rights and claims for damages I may have against Chad Nicholls, Kim Chizevsky, The National Physique Committee of the U.S.A., Inc. (the NPC), the Remingtons entertainment complex, or the agents, employees, representatives or assigns of any of the foregoing persons or entities for any and all injuries or damages I may incur while traveling to and from, or participating in, this competition (ii) I certify that I am an amateur in good standing and am eligible to compete in this competition in the division(s) in which I have entered, and (iii) I further agree to abide by all decisions of the NPC and declare that all information contained herein is, to the best of my knowledge, true, correct and complete.

Competitors Signature_____________________________ Parent/Guardian Signature (If under 18 years of age) _____________________________ NPC CARD#______________________________________ COMPETING IN: Check Division(s) entered please note Submit $50.00 for EACH Division entered
______Mens Novice BB ______Mens Open BB ______Masters Men BB ______Womens Novice BB ______Womens Open BB ______Masters Women BB ______Wheelchair ______ Figure ______Womens Physique ______Masters Figure ______Masters Women Physique ______ Bikini ______Mens Physique ______Masters Bikini ______Master Mens Physique ______Womens Fitness

ENTRY FEE: $50.00 For EACH Class entered NO REFUNDS ______Teen Men
Cut along line below and mail with check, cash or money order to:

Chad Nicholls, P.O. Box 9101, Springfield, MO 65801

YOU MUST LIST YOUR WEIGHT AND/OR HEIGHT BELOW:

*Entries must be postmarked by JULY 2, 2012 to avoid $50.00 late fee.

_____________________________________________________________

ALL ENTRY CONFIRMATIONS WILL BE SENT VIA EMAIL

Weigh/Check-In: Date & Times: Place: Promoters: Divisions:

MANDATORY CHECK-IN WEIGH-IN FOR ALL COMPETITORS IN ALL CLASSES - FRIDAY, JULY 13, 2012 5:00 p.m. 7:00p.m. -REMINGTONS ENTERTAINMENT COMPLEX, 1655 WEST REPUBLIC ROAD, SPRINGFIELD, MO SATURDAY, JULY 14, 2012 MEETING 9:30 A.M. PRE-JUDGING 11:00 A.M. MEETING 6:30 P.M. FINALS 7:00 P.M. REMINGTONS ENTERTAINMENT COMPLEX, 1655 WEST REPUBLIC ROAD, SPRINGFIELD, MO Chad Nicholls & Kim Chizevsky; P. O. Box 9101, Springfield, MO 65801; Phone: 417-875-6320
Men: Bantam Wt. 143 and under, Light Wt. over 143 and up to and including 154 , Middle Wt. Over 154 and up to and including 176 , Light Heavy Wt. - over 176 and up to & including 198 , Heavy Wt. - over 198 and up to & including 225, Super Heavy Wt. -over 225 Women: Light Wt. 114 and under, Middle Wt. over 114 and up to & including 125 , Heavy Wt. - Over 125 Masters Men: 4 Classes 35 39 years old, 40 49 years old , 50 - 59 years old and 60 & older; Masters Women: 1 class 35 & Over Novice Men Light Wt. Up to and including 154 , Middle Wt. Over 154 and up to & including 176 , Light Heavy Wt. Over 176 and up to & including 198 , Heavy Wt. Over 198 Novice Women: 2 Classes - Light Wt. 120 and under, Heavy Wt. Over 120 Teen Men One Class - Fitness Competitors One Class - Figure Competitors Two classes; A & B, Masters Figure Competitors One Class 35 years old and over - Bikini Competitors - Two Classes A & B - Masters Bikini Competitors - One Class 35 years old and over - Wheelchair Division Mens and Womens classes Mens Physique One Class - Masters Mens Physique - One Class 35 years old and over Womens Physique One Class - Masters Womens Physique - One Class 35 years old and over ALL COMPETITORS: (Those athletes competing in the Missouri State portion of the show MUST BE A MO or KS STATE RESIDENT!) (1) Each competitor must be currently registered with the NPC. To meet this requirement, he/she must present his/her current NPC card, current NPC Receipt, or purchase an NPC card at this event ($100). (2) Each competitor must be an amateur in good standing with the NPC. (3) Any competitor who has won a higher level overall title, or who is nationally qualified due to his/her placing in a national level competition is not eligible for this event. (4) MASTERS (Men & Women): Each competitor in these Divisions also (1) by July 14, 2012 must have reached the age for the respective Masters class in which he/she has chosen to compete (2) and must provide proof of age with a birth certificate, drivers license, state i.d. FIGURE & BIKINI: Consists of one (1) round two-piece swimsuit. FITNESS: Consists of two (2) rounds two-piece swimsuit & routine round. TEEN CLASSES: Each competitor in these Divisions must (1) have reached his or her 13th birthday, but not his 20th birthday, by July 14, 2012, and (2) must provide proof of age with a birth certificate, drivers license or state i.d. MENS PHYSIQUE: Consists of one (1) round Surf style board shorts. No shirt, sneakers or sandals are to be worn on stage. BEAUTIFUL SWORDS will be presented to places 1 5 in all classes. Custom awards will be presented to the Mens and Womens Overall Champions. Places 1st and 2nd in the Mens & 1st 3rd in ALL Womens classes are qualified for one (1) year to compete in all NPC National Level Events. ABSOLUTELY NO DREAM TAN IS TO BE USED!!! Light Oil is allowed. Athletes who compete in the pre-judging must compete in the evening show. Solid-color posing suits only no T-back suits permitted. No jewelry is permitted (except wedding rings). Women only may wear multicolored suits and earrings to the EVENING SHOW. Athletes must exhibit good sportsmanship at all times. Only competitors and officials are allowed backstage and in the pump-up room. NO EXCEPTIONS NO KIDDING! CURRENT NPC RULES APPLY. All athletes will be presented and perform posing routines to music in the Evening Finals. Each athlete must provide 2 CDs with 90 seconds of routine music. CDs must be cued to the beginning of the CD CDs containing multiple songs will NOT be accepted. NO PROFANITY ALLOWED in music! Discounted lodging is available through the Residence Inn Springfield (417) 890-0020 (Please mention the Missouri State Championships to obtain a discounted rate) All reservations must be made no later than July 2, 2012 TO SECURE YOUR ROOM.

Eligibility:

Awards: Rules:

Posing/ Music: Hotel: