American Powerlifting Committee National Bench Press Championships.
February 11, 2006
Warner Robbins,  Georgia, USA

Name___________________________________________________________

Address__________________________________________________________

City _______________________State__________Zip______________________

Phone________________________________ Birth date____________________

Email____________________________________________________________

Check all appropriate categories in each column below:



__Bench Meet

__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, Nadine 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_______________________________________________________

Entry fee: $70.00 – Team entry - $50.00.

24 hour weigh in beginning at 10:00 Friday February 10, 2006 at the Holliday Inn in Warner Robins, Ga. 

Entry Deadline February 1, 2006  No Late Entries

Send check payable to Meet Director and entry form to: Meet Director, P O Box 40, Bogart, Ga. 30622,  770-713-3080
www.irondawg.com www.americanpowerliftngcommittee.com

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