UNITED STATES MUAY THAI ASSOCIATION
Official member of the WMTC, AMTAT, WAMTO, WMTF, EMTU, ABC
National Office: Suite 1K, 6535 Broadway, New York, New York. 10471
USMTA STANDARD MEMBERSHIP APPLICATION
AGREEMENT made between the United States Muay Thai Association, and
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? __________________________________
YES [ ] NO [ ]Do you have any Muay Thai Judges or Referees experience?
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 Muay Thai 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 C. HEYLIGER
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