Name___________________________________________________________

Address__________________________________________________________

City _______________________State__________Zip______________________

Phone________________________________ Birth date____________________

Email____________________________________________________________

Check all appropriate categories in each column below:

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 Holiday 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.

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.