APC Region 5 Powerlifting and BenchPress Championships.
October 16, 2010
Name___________________________________________________________
Address__________________________________________________________
City _______________________State__________Zip______________________
Phone________________________________ Birth date____________________
Email____________________________________________________________
Check all appropriate categories in each column below:
Raw___
Equipped____
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__Powerlifting Meet |
___Open ___Junior 20-23 Teenage: ___Sub-master 35-39 |
Master: ____40-44 |
Weight Class: Women: __44K |
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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/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 Stephen Parkhurst, The American Powerlifting Committee, Fitness
America and staff, all Officials, Referees, Spotter/Loaders and any other person
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.
24 hour weigh-in starts Friday at 10:00AM - 12:00 and 6:00PM - 8:00PM at Fitness America. Saturday weigh-ins from 8:00 am to 9:00 am
Contest starts at 10:00AM Saturday at Fitness America
Powerlifting $30.00- Benchpress- $30.00. To enter both championships or multiple
divisions- $50.00. APC membership cards will be required and may be purchased at
the contest. $30.00 for adults, $15.00 for teenagers.