Affiliate Membership

Affiliate Membership Registration

Please select type of membership:

Company Membership @ $500.00 (1 year)
Non-Profit Membership @ $300.00 (1 year)
Individual Membership @ $100.00 (1 year)

Company/Individual Name:*

As you would like to have listed on the website/newsletters

Address:*

City:*

State:*

Zipcode:*

Phone:*

E-Mail:*

Mailing Address of where newsletter should be mailed (if different from above)

Company/Individual Name:

Address:

City:

State

Zipcode:

Verification Code:

For Company and Non-profit Organization Memberships:
LOGO Guidelines:
Your logo will be used in a variety of ways to promote your membership with the USPSA. Therefore, a high-resolution logo in an electronic format is preferred. An .eps is the preferred format, however, a high resolution .jpeg or .tif will also be accepted. Please email your company logo to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

PAYMENT INFORMATION:

To pay by check:
Please make your check payable to USPSA and mail with this form to: USPSA, PO Box 1181, Carmel, IN 46032

To pay on-line:
www.powersoccerusa.net > Memberships > Choose your membership type. Credit cards are accepted through Pal Pal.