10th Annual American Powerlifting Committee
National Powerlifting Championships
.Clarion Hotel, 6288 Old Dixie Hwy., Jonesboro, Ga. 30236
June 1, 2, 3,  2012
Mail to:
L B Baker, P O Box 40, Bogart, Ga. 30622 USA

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 L B Baker,  Svetlana Baker, IronDawg Power, Inc.,  The American Powerlifitng Committee, Inc., 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.

Signature________________________________________________________                      APC card number______________________________

Parent or guardian if under 18_________________________________________

Powerlifting $90.00- Pushpull Meet $80.00 - Bench Press- $70.00 - Deadlift Meet $70.00.  Team entry fee $50.00
Any combination of 2 or more meets will be $20.00 less than the total.
Entry deadline May 22, 2012,  Late entry $20.00

Send check payable to Irondawg Power and entry form to: Irondawg Power, P O Box 40, Bogart, Ga. 30622, Phone  770-713-3080 www.irondawg.com      www.americanpowerliftingcommittee-usa.com email lbbaker@irondawg.com

back