Athlete Protection Program (Previously SafeSport)

USA Powerlifting Athlete Protection Program
Questions? Please contact referees@usapowerlifting.com Do not email the National Office.

USA Powerlifting Membership Required.

If you are not currently a member, or if your membership has expired, please go to the USA Powerlifting website and submit your Membership Application prior to completing this form.
Name

First NameLast Name
E-mail
Phone Number:

Area CodePhone Number
Mailing Address:

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Birth Date:

MonthDayYear
Age:
Sex:
Athlete Protection Program Details
Referee
Meet Director
Coaching Level
Other
This Option is to only be used you do not fall into the Referee, Meet Director or Coaching Level options.
Athlete Protection Course Completion Date

MonthDayYear
You only need to upload the Athlete Protection Program Training certificate from Thinkific, PDF format only!
Athlete Protection Certificate

Upload a File
Upload PDF format Only Cancelof
By submitting this request, you are granting permission to USA Powerlifting to request a background check on your behalf. A separate email will be sent to you from JDP, our vendor for background checks that will require you to respond to the email with the information required for them to complete the background check.
Background
SafeSport
Total
Background Check / Athlete Protection

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Signature
USA Powerlifting Membership #
Should be Empty:

USA Powerlifting Athlete Protection Program