APC Salute To The Troops
Novmeber 4, 5, 2017
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

__Bench Meet

---Deadlift Meet

__Pushpull Meet

__Team Entry

Team Name:
___________

___Open

Teenage:
___13-15
___16-17
___18-19

___Junior 20-23 

___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:

__44Kg
__48Kg
__52Kg
__56Kg
__60Kg
__67.5Kg
__75Kg
__82.5Kg
__90Kg
__100Kg

__100+kg

 


Men:
___52Kg
___56Kg
___60Kg
___67.5Kg
___75Kg
___82.5Kg
___90Kg
___100Kg
___110Kg
___125Kg
___140Kg
___140+Kg

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