United Powerlifting Association, LLC Membership Application

*UPA MEMBERSHIPS CAN ONLY BE PURCHASED ONLINE. *

New (1 year membership)

Renewal (1 year membership)

Replacement Card (This is not a membership renewal. This is if you lost your unexpired membership card.)

UPA Membership Card #

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number (___)___-____ *

Email Address *

Age *

Date of Birth * +

Event Pricing *

$40 for Adult Membership Fee

$25 for Teenager Membership Fee (19 & under)

$5 for Replacement Card (Only if Membership has not expired)

5%

PayPal Fees (required) *

Comments or Questions