Membership Application
In consideration of my acceptance as a member of the 365 SWPF I hereby release the 365 Strong World Powerlifting Federation (365 SWPF), Federation President Bill Clary, all event facilities, meet hosts, event staff, meet directors, referees and meet volunteers from any responsibility or liability for any injury or personal illness or loss to myself resulting from participation in a 365 SWPF event.
I acknowledge there is risk of injury in the sport of powerlifting. I accept the risk of injury or illness that may be directly or indirectly linked to my competing in or attending a powerlifting event. I am aware that I will be solely responsible for my lift attempt decisions and for the condition and safety of my lifting gear, bench press shirts, powerlifting suits, wraps, etc. when participating in 365 SWPF events.
I am responsible for my behavior and that of my guests at any federation sanctioned event. If asked to leave an event due to my or their behavior I will do so immediately and voluntarily and forfeit any entry costs I may have incurred for the event.
I will allow the 365 SWPF to use my photos or videos, if they so choose, to promote me, my accomplishments and the federation as a whole.
I hereby represent and warrant that I have reviewed and understand the terms of acceptance prior to electronically submitting and signing this waiver/lifetime membership application form.
If I am under the age of 18 my parent or legal guardian will review and electronically sign and submit this entry form assuming responsibility for me.
365 SWPF Membership options and fees:
* VIP Lifetime Adult Membership
Card is a one-time fee of $70.00
* VIP Lifetime Youth, Teenage and M/P/F Membership
is a one-time fee of $55.00
* Annual Adult Membership
Card is an annual fee of $40.00
* Annual Youth, Teenage and
M/P/F
is an annual fee of $30.00
* Upgrade
- from any past or current Annual membership to VIP Lifetime Membership - $45.00 (to become a VIP Lifetime member)
Pay online or Make Checks Payable to: 365 Strong World Powerlifting Federation or 365 Strong. Mail to: 365 Strong, PO Box 253, Fort Mill, SC 29716 Email: info@365strong.org. Your membership card will be mailed to you within 5-7 business days. If your card is lost or stolen a replacement card is $10.
Member Name
As it will appear on your membership card
Phone
Email
You will receive an activation link and the recipe of the fully completed registration form.
Date of Birth
Gender: (M or F)
(M)ale or (F)emale
How did you hear about 365 Strong Powerlifting Federation?
Referring Member: (if applicable)
Address
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts & Nevis
St Lucia
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Other
Membership Type:
ADULT LIFETIME MEMBERSHIP
YOUTH, TEEN OR M/P/F LIFETIME MEMBERSHIP
ADULT ANNUAL MEMBERSHIP
YOUTH, TEEN OR M/P/F ANNUAL MEMBERSHIP
UPGRADE-ANNUAL TO LIFETIME
Gym, Team or Country
Home Gym Location
National Origin
Are you presently a referee with another organization?
Yes
No
Are you a member of another lifting organization? If so, which one(s)?
Parent or Guardian Approval (if 18 years of age or under)
Mandatory if 18 or under!
Parent or Guardian Contact Information:
Mandatory if 18 or under!
Lifter Signature:
We'll accept a scanned or typed signature.
Comments
SUBMIT FORM
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