Office Use Only:___________________
                                                                                               (membership number)


                       Individual Membership Application

    United States All-Round Weightlifting Association



Name:___________________________________________________

Address:__________________________________________________

City:_____________________State:_______________Zip:_________

Phone:_____-_____-_______  Date of Birth:_____________________

Club Affiliation:_____________________________________________

Pledge: I agree to abide by the rules of the United States All-Round Weightlifting Association, the International All-Round Weightlifting Association, and I understand that this membership will be revoked if I violate those rules.



                     Member's Signature:________________________

                     If member is under 21, parent/guardian must sign:

                      _________________________________________


Fee: $25 Annually
Make checks payable to the USAWA

Return to:

Bill Clark *3906 Grace Ellen Drive*Columbia, Missouri  65202-1796