IronDawg Open Record Setters Bench Press
January 23, 2010
Phone________________________________ Birth date____________________
Check all appropriate categories in each column below:
Weight Class: Women:
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