AMERICAN POWERLIFTING COMMITTEE
MEMBERSHIP APPLICATION
*APC MEMBERSHIPS CAN ONLY BE PURCHASED ONLINE. *
New (1Year Membership)
Renewal (1 Year Membership)
Replacement Card
APC Membership Card #
First Name
*
Last Name
*
Street Address
*
Address Line 2
City
*
State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number (___)___-____
*
Email Address
*
Age
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Membership Options
*
Adult Membership ($30)
Teen Membership ($15)
Special Olympian ($10)
Card Replacement ($5)
Comments or Questions
Signature
Back
Next
Next >>
Next >>
Membership Options
*
prev
next
( X )
APC Adult Membership
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
APC Teen Membership
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
APC Special Olympian Membership
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Replacement Card
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Back
Next
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Should be Empty: