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Hosting Request - USA Powerlifting Club Course
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* Indicates required question
Email
*
Your email
Your name
*
Your answer
What is your connection to the venue in which you are requesting to host?
*
Owner
Employee
Member
Other:
Venue Name
*
Your answer
Venue Address
*
Your answer
Venue Website / Social Media
*
Your answer
Proposed Date (s)
*
Please list in order of preference.
Your answer
Time of Course
*
The courses 1 day and typically run from 9am to 6pm local time. What is your requested time?
9am to 6pm local time
Other:
Do you have approval from your
State Chair
to host this event at the proposed location, on the proposed date(s)?
*
Yes
No
Number of people that you know are willing to take this course on the proposed date/location?
*
Your answer
Preferred Instructor
*
Zac Cooper
Matt Gary
Larry Maile
Josh Rohr
Paulie Steinman
No Preference
Additional Info or Questions
Your answer
A copy of your responses will be emailed to the address you provided.
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