American Powerlifting Committee
Powerlifting and BenchPress National Championships
June 3rd, 4th, and 5th 2011
hosted by
The Stoney Creek Inn
101 Mariners Way (Access Road 6)
East Peoria Illinois 61611
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 Team Name ___________ |
___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, The Stoney
Creek Inn 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.
The American Powerlifting Committee National Championships is the United States qualifier for the WUAP World Championships for equipped athletes and the Global Powerlifting Alliance World Championships for RAW athletes.
Contest and weigh-ins will be daily at The Stoney Creek Inn, 101 Mariners Way, East Peoria IL 61611. Please refer to the lifting and weigh-in schedules available at
www.americanpowerliftingcommittee.com