IronDawg Open Record Setters  Bench Press Championships.
January 23, 2010
Athens Moose Lodge
185 Ben Burton Rd.
Athens, Georgia, 30622 USA

Name___________________________________________________________

Address__________________________________________________________

City _______________________State__________Zip______________________

Phone________________________________ Birth date____________________

Email____________________________________________________________

Check all appropriate categories in each column below:

Raw___                  Equipped____



__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

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,  IronDawg Power,  The American Powerlifitng Committee, The Athens Moose Lodge 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 Athens Moose Lodge.

Contest starts at 10:00AM Saturday at the Athens Moose Lodge

Bench Press $70.00 - Benchpress- 2 classes $120.00

Entry deadline January 15,  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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