
A.P.C.
NATIONAL
Powerlifting/Benchpress Championship
June 5-7, 2009
Packard Plaza, 225 N.E. Adams St. Peoria, IL.
Name____________________________________________Address___________________________________________________________
City ___________________________
State__________Zip____________Phone________________________________
Birth date____________________ Email
Address____________________________________________________________
Check all appropriate categories in each column below:
Raw___
Equiped____
|
__Powerlifting Meet
__Bench Meet
__Both Meets
__Team Entry
Team Name:
___________
|
___Open
___Junior 20-23
Teenage:
___13-15
___16-17
___18-19
___Sub-master 35-39
|
Master:
____40-44
____45-49
____50-54
____55-59
____60-64
____65-69
____70-74
____75-79
____80-84
____85-89
|
Weight Class: Women:
__44K
__48K
__52K
__56K
__60K
__67.5K
__75K
__82.5K
__90K
__90+K
|
|
Men:
___52K
___56K
___60K
___67.5K
___75K
___82.5K
___90K
___100K
___110K
___125K
___140K
___140+K
|
Contest starts at 10:00AM each day at the Packard Plaza,
Peoria, IL.
Full Power or Benchpress- $85.00 Each additional division $35.00
Entry deadline post marked by May 22, 2009. Late entry fee $25.00
Mail Payment and Entry Form: Greg Gordon 1405 Kelsey Street, Washington, IL.
61571
24 hour weigh-in starts Thursday, Friday, and Saturday at 10:00AM - Noon
and 6:00PM - 8:00PM. Contest morning weigh-in 8:00am – 9:00am at
the Mark Twain Hotel next to the Packard Plaza. The Benchpress contest will be
run simultaneously with the full power meet, so the lifter only has to bench
once for dual entries. Valid state ID required for teen and masters entries.
An APC membership card is required to lift in this contest. Men and Women $30
Teens $15. You can purchase a card at weigh-in or on the APC website.
www.americanpowerliftingcommittee-usa.com
Release from Liability.
Please Read this
carefully.
By signing this release you will be giving up important rights. As a
participant, I understand that I am participating in a sport in which injury may
occur. In consideration of my acceptance of my entry form in this powerlifting/benchpress
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 from
liability I waive and release Gregory P. Gordon, Stephen H. Parkhurst, the
American Powerlifitng Committee, The Packard Plaza and staff, all Officials,
Referees, Spotter/Loaders and any other person(s) 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________________________________________
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