APC Americas Cup Powerlifting Championship
September 17, 2016
Iron Beast Gym
675 Grove Street
Gainesville, Ga. 30501
Name____________________________________________________________
Address__________________________________________________________
City _______________________State__________Zip______________________
Phone________________________________ Birth date____________________
Email____________________________________________________________
Check all appropriate categories in each column below:
Raw___
Equipped____
__Powerlifting Meet
---Deadlift Meet |
___Open
Teenage:
___Sub-master 35-39 |
Master:
____40-44 |
Weight Class: Women:
__44Kg |
|
|
Release from Liability, Read this
carefully: By signing this you will be giving up important rights, in
consideration of my acceptance of my entry form in this powerlifting
competition, I understand that I am legally bound for not only myself but also
for my heirs, my executors, and my administrators in signing this release form
liability I waive and release Anthony Williamson, James Houston, Marcell Allen,
Stephanie L Williams, IRON BEAST GYM, American Powerlifting Committiee, Inc.,
Irondawg Power, Inc., L B Baker, Svetlana Baker and all Officers of the APC..
All Officials, Referees, Spotter/Loaders and any other persons or firm taking
part in this competition from any and all liability which may arise from this
competition, I understand all of the above for my acceptance of my entry in this
competition, By signing this entry form I affirm that all the information on
this form is correct
Signature________________________________________________________
APC Card Number_______________
Parent or guardian if under 18________________________________________
Powerlifting $75.00----Pushpull $65.00---- Bench $55.00--- Deadlift $55.00
Send check and entry form to Iron Beast Gym, 675 Grove Street, Gainesville, Ga. 30501