APC National Powerlifting Championship
June 24, 25, 2017
Iron Beast Gym
675 Grove Sreet
Gainesville, Ga. 30501



City _______________________State__________Zip______________________

Phone________________________________ Birth date____________________


Check all appropriate categories in each column below:

Raw___                  Equipped____

__Powerlifting Meet

__Bench Meet

---Deadlift Meet

__Pushpull Meet

__Team Entry

Team Name:



___Junior 20-23 

___Sub-master 35-39



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 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 form liability I waive and release Anthony Williamson, Marcell Allen, Stephanie L Williams, IRON BEAST GYM, American Powerlifting Committiee, Inc. and all Officers.   All Officials, Referees, Spotter/Loaders and any other persons 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________________________________________

Powerlifting $100.00----Pushpull  $90.00---- Bench $80.00--- Deadlift $80.00, Crossover $50.00

Send check and entry form to Anthony Williamson 1610 Oconee Point Jefferson Ga 30549