UNITED STATES MUAY THAI ASSOCIATION
Official member of the WMTC, AMTAT, WAMTO, WMTF, EMTU, ABC International Office: Suite 1K, 6535 Broadway, New York, . 10471
INTERNATIONAL AFFILIATE MEMBERSHIP APPLICATION
AGREEMENT made between the United States Muay Thai Association, and the named,
Mr./Mrs./Ms._______________________________________________
Address_________________________________________________
City ________________ State_________ Zipcode_______________
Tel(home):__________ Email:__________ Fax:_________________
[ OTHER MARTIAL ART EXPERIENCE (if any) ]
School name:_________________ Instructor:________________________
Rank/Grade or Title (if any):_______________ Years Exp:_______________
Do you belong to an association your own country?____________________
Do you have any Muay Thai Judges or Referees experience in your own country?
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: $45.00 MEMBERSHIP No.:______________
MAKE CHECK OR MONEY ORDER TO C. HEYLIGER
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