USA Powerlifting Gym Affiliation

USA Powerlifting Gym Affiliation
Primary Contact Name *

First Name Last Name
E-mail *

Confirmation Email
Phone Number: *

Area Code Phone Number
New/Renewal *
Gym Name *
Gym Website (If applicable)
GYM LOGO

Upload any logos you would like approved to wear at a USA Powerlifting event. This includes anything text or logo imprinted on any part of the apparel, (shirt front, back, sleeves, singlets, belts, socks, headbands, etc).

Logos are subject to approval.
Primary Gym Logo
pdf, jpg, jpeg, png
Upload Secondary Gym Logo(s)

Browse Files
pdf, jpg, jpeg, png Cancel of

Address: *

Payment *

Gym Level $ 150.00

Affiliation Level
I certify by signing below, the gym listed in this affiliation does not carry, sell or distribute any WADA prohibited supplements or substances.
Authorized Signer

Clear
Enter the message as it's shown *
Should be Empty: