APC National Powerlifting Championship
June 23-24, 2018
Titanz Fitness
280 Banks Crossing Dr.
Commerce, Ga. 30529

Name____________________________________________________________

Address__________________________________________________________

City _______________________State__________Zip______________________

Phone________________________________ Birth date____________________

Email____________________________________________________________

Check all appropriate categories in each column below:

Raw___                  Equipped____

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, The American Powerlifting Committee, Inc., Irondawg Power Inc.,  Titanz Fitness of Northeast Georgia, Jon Williams, L B Baker, Svetlana Baker, all Officials, Sponsors, Referees, Spotter/Loaders, and any other persons or firms 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

back