2021 Bisbee Physique Official Entry Form

✉ shane@shaneearly.com

DEADLINE FOR ENTRY IS MONDAY, NOVEMBER 1st, 2021

Please take your time and fill out this form in as much detail as you can. The more detailed information you give, the better we'll be able to help!

*(Promoter reserves right to change classes based on participation. Bodybuilding will be based on weight other classes will be based on height)

When you've filled everything out, please click on the "Complete & Send" button at the very bottom.

First Name *

Last Name *

Your height : *

Your current weight : *

Address

Street Address *

City *

State *

Country *

Postal code *

Email *

Phone *

Age: *

CLASS YOU INTEND TO COMPETE IN (Please Select One): *

Athlete Bio: This can be anything, people you would like to thank, competitive history, inspirations, etc. *

Attach photos or files *

Click or tap the button and then mark all of the files that you would like to attach

RELEASE

In consideration of being allowed to participate in any way in the Bisbee Physique promoted by Shane Early its related events and activities, I, acknowledge, appreciate and agree that: 1.The risk of injury from the activities involved in this event are my responsibility and I take sole responsibility. I hereby indemnify, and hold harmless the promoter, his associates, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers and Bisbee High School, with respect to any and all injury, loss or damage to person or property associated with my presence at or participation in or in traveling to and from the Event.

I hereby grant Shane Early (Promoter) and his photographer 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 on digital 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. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

CHECKLIST (Include): 1. Entry Form 2. Entry fee of $100 Cash, Check, Stripe or PayPal (Shane@shaneearly.com) to Shane Early.

If you have questions, contact us at:

Shane Early (520) 226-1065

Email: Shane@shaneearly.com

Website: Shaneearly.com

Facebook: https://www.facebook.com/groups/BisbeePhysique/?ref=br_rs

*

By checking this box you are in full Agreement with this Release.

Type your name in this box, this is your e-Signature. *