Name___________________________________________________________

  Address__________________________________________________________

  City_______________________State__________Zip______________________

  Phone________________________________Birthdate____________________

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

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, American Powerlifting Committee, Inc. 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 - $75.00 – Team entry - $60.00 – Benchpress- $65.00 - Both   $130.00
Entry Deadline June 12, 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
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