USA Powerlifting Gym Affiliation

USA Powerlifting Gym Affiliation
Primary Contact Name*

First NameLast Name
E-mail*

Confirmation Email
Phone Number:*

Area CodePhone Number
New/Renewal*
Gym Banner*
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

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Upload Secondary Gym Logo(s)

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Address: Please no PO Boxes as our courier will not deliver to PO Boxes only physical addresses.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Payment*
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Gym Level$500.00

Affiliation Level

Extra Banner$65.00

Quantity

Total $0.00
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

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