2004 Georgia State Open Powerlifting and Bench Press Championships. 
Saturday, April 3, 2004
Holiday Inn Express, Athens, Georgia)
 Lifting starts at 10:00am.   APC/UAPC rules apply.
**Weigh in times:  4/2/04: 10am-12noon, 6pm-8pm Sat. 7:30-9am**

  Name___________________________________________________________

  Address__________________________________________________________

  City_______________________State__________Zip______________________

  Phone________________________________Birthdate____________________

  Email____________________________________________________________ 
APC/UAPC Card # _______________ (if you have no card, you can buy one at the meet)

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, Nadine Baker, IronDawg Power, 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________________________________________________________

Parent or guardian if under 18________________________________________

Entry fee:  powerlifting - $70.00 – Team entry - $50.00 – Benchpress- $60.00 - Both   $120.00
Entry Deadline March 26, 2004 $20.00 late fee
Send check payable to Meet Director and entry form to:  Meet Director, P O Box 40, Bogart, Ga. 30622,  Phone 770-725-6684   cell 770-713-3080 www.irondawg.com  www.americanpowerliftngcommittee.com