APC Americas Cup International  Powerlifting Championships.
October 13, 2012
IronDawg Power
P O Box 40
Bogart, Georgia, 30622 USA

Name____________________________________________________________

Address__________________________________________________________

City _______________________State__________Zip______________________

Phone________________________________ Birth date____________________

Email____________________________________________________________

Check all appropriate categories in each column below:

Raw___                  Equipped____

High School___Name of School____________________________________________

__Powerlifting Meet

__Bench Meet

---Deadlift Meet

__Pushpull Meet

__Team Entry

Team Name:
___________

___Open

___Junior 20-23

___High School 

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:

__44Kg
__48Kg
__52Kg
__56Kg
__60Kg
__67.5Kg
__75Kg
__82.5Kg
__90Kg
__90+Kg

 


Men:
___52Kg
___56Kg
___60Kg
___67.5Kg
___75Kg
___82.5Kg
___90Kg
___100Kg
___110Kg
___125Kg
___140Kg
 ___140+Kg

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,  The American Powerlifitng Committee, The Holiday Inn Express 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.

Signature________________________________________________________    APC Card Number_______________

Parent or guardian if under 18________________________________________

24 hour weigh-in starts Friday at 10:00AM - 12:00 and 6:00PM - 8:00PM at the Holiday Inn Express..

Contest starts at 10:00AM Saturday at the at the Holiday Inn Express, 513 East Broad Street, Athens, Ga. 30601.

Powerlifting Meet $80.00 - Pushpull Meet $75.00 - Benchpress Meet - $70.00 - Deadlift Meet $70 .  Team entry $50.00.  Any combination of 2 or more meets is $20.00 less the total.
  Entry deadline October 8,  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.americanpowerliftngcommittee.com

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