Application
Global Powerlifting Alliance, Inc.
P O Box 40
Bogart, Ga. 30622
USA
Email: lbbaker@irondawg.com

“GPA Certified Special Olympian-Paralympian PowerliftingTrainer”
-Certification-

Name_____________________________________________________________________________

Address___________________________________________________________________________

City, State, Zip code, Country___________________________________________________________

_________________________________________________________________________________

Date of birth________________________________________________________________________

Telephone number___________________________________________________________________

Email_____________________________________________________________________________

1.   Years as a "GPA Certified Powerlifting Trainer" _____A minimum of one(1) year as a GPA Certified PowerliftingTrainer is required.

2.   Date certified as a "GPA Certified Powerlifting Trainer.   Month_____________Day____________Year____________.

3.   Submit this application along with the non refundable fee of $100.00 to the Global Powerlifting Alliance, Inc., P O Box 40, Bogart, Ga. 30622 USA.

4.  Complete a written examination and other requirements as required by the GPA Certified Special Olympian-Paralympian Executive Committee.

Release From Liability. Read this carefully:

       In signing this release from liability I waive and release L B Baker, Svetlana Baker, IronDawg Power, Inc. and all its subsidiaries, the American Powerlifitng Committee, Inc., the Global Powerlifting Alliance, Inc., the Internatonal Powerlifting Organization, all Officials, Referees, Spotter/Loaders and any other person or firm taking part in any APC/GPA/IPO competition or training system designed by any "GPA Certified Powerlifitng Trainer"  certified person from any and all liability which may arise from this Certitication   I understand that I am legally bound for not only myself but also for my heirs, my executors, and my administrators.  I understand all of the above for my acceptance of my entry in this organization. By signing this document I affirm that all the information on this form is correct.

Applicant must be at least 21 years of age.

Signature________________________________________________________-                           Date______________________________________

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