USMTA logo Copyright USMTA 1990- 2008

UNITED STATES MUAY THAI ASSOCIATION

National Office: Suite 1K, 6535 Broadway, New York, New York. 10471 Official member of the WMTC, AMTAT, WMTA, WMTF

AFFILIATE MEMBERSHIP APPLICATION

AGREEMENT made between the United States Muay Thai Association, and the below named,

Mr./Mrs./Ms.______________________________________

Address________________________________________________________

City _________________    State:_______________      Zipcode:_________

Tel(home):_______________  Email:_______________   Fax:____________

[MARTIAL ART EXPERIENCE (if any)]

School name:___________________________________________________

Instructor: ______________________________________________________

Rank/Grade or Title (if any):_________________ Years Exp: _____________

Do you belong to an association? ___________________________________

Do you have any Muay Thai Judges or Referees experience? YES [    ] NO [    ]

I have read the information and have agreed to be officially registered as a member of the United States Muay Thai Association (hereinafter called "USMTA"). Doe agree to abide by the Rules and Regulations of the USMTA who are certified and recognized in accordance of the charter of the WMTC. Do understand that the USMTA and its Officials are the Official American Representatives of the (WMTC) World Muay Thai Council, (AMTAT) Amateur Muay Thai Association of Thailand and (IFMA) International Federation of Muay Associations of Bangkok, Thailand, under the recognition of the Sports Organization of Thailand. Do understand that if I wish to become a competitor in Muay Thai that I must license myself as either an Amateur or as a Professional with the USMTA and that I must also be licensed by my State Commission. As a USMTA member, I have promised to uphold the true spirit of Muay Thai its rituals and ceremonies. Will act in accordance with the USMTA, for my country and its representation of the World Muay Thai Council. Do understand that any falsifying, or misrepresentation of all documents, logos and emblems which belong to and are Copy written by the USMTA, or any conduct that would discredit the USMTA, my fellow members or the USA, could result in the termination of my membership from the USMTA. Do agree to pay the Annual Fee.

Title:__________________ Signature:______________________


Official use only

USMTA Official: __________________  Date: _________________

Annual Membership Fee: $20.00     MEMBERSHIP No.:_____________

MAKE CHECK OR MONEY  ORDER TO USMTA

Copyright Protected 1999 USMTA. Inc.  All rights reserved.1999-2011

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Copyright Protected 1993 -2011 USMTA. Inc. USMTA. Inc. All rights reserved.