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 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
pdf, jpg, jpeg, png
Upload Secondary Gym Logo(s)

Browse Files
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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

City State / Province

Postal / Zip Code Country
Payment *
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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

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