APC Georgia State Championships
March 24, 2018
Titanz Fitness
280 Banks Crossing
Commerce, Ga. 30529
Name____________________________________________________________
Address__________________________________________________________
City _______________________State__________Zip______________________
Phone________________________________ Birth date____________________
Email____________________________________________________________
Check all appropriate categories in each column below:
Raw___
Equipped____
__Powerlifting Meet
---Deadlift Meet |
___Open
Teenage:
___Sub-master 35-39 |
Master:
____40-44 |
Weight Class: Women:
__44Kg |
|
|
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 from liability I waive and release
Anthony Williamson, Marcell Allen, Jon Williams, 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