USA Powerlifting Lake Pleasant Classic 2018

Battle of the Bench 2025

Registration Form
Presented by:

in conjunction with

Granville County Sheriff's Office

Deputy Robert Fountain, III

robert.fountainIII@granvillcounty.org

984.331.9239
Athlete Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
E-mail*
An email address that we can contact you in case of any unforeseen changes.
Date of Birth*

MonthDayYear
Date
Male or Female*

MaleFemale
Parent/Guardian Information

If under the age of 18
Parent/Guardian

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
E-mail
Emergency Contact Information
Emergency Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail
Divisions & Weight Class

$5 Exceptional Athletes ~ $10 Middle School ~ $20 High School ~ $40 for Open Category ~ $100 for Lifting Teams (up to 10 members)
Please Select Division

Exceptional AthleteMiddle SchoolHigh SchoolOpen CategoryTeam*
*Please provide team name Type a label
Please List Team Members
Please Select Weight Class

114132148165181198220242275308+
*There are no refunds for any reason. Upon receipt of your registration fee, your transaction is deemed final.*
Payments should be made to

GRANVILLE COUNTY SHERIFF'S OFFICE

Checks* or Money orders only

*There will be a $25 fee for returned checks.

Mail payment and Waiver to

GRANVILLE COUNTY SHERIFF'S OFFICE

525 New Commerce Drive Oxford, NC 27565

$20 Registration Fee will be assessed on entries postmarked after June 20th.
Should be Empty:

Battle of the Bench 2025

Athlete Information

Parent/Guardian Information

Emergency Contact Information

Divisions & Weight Class