USAT-MAC :: State Association

Application to Establish a

USAT-MAC State Association

1. Name of New State Association*

2. Applicant's Name (Applicant will be Contact Person throughout application process)*

First Name Last Name

Applicant's USAT Member #*

Applicant's Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Applicant's E-mail Address*

Applicant's Phone Number*

- Area Code Phone Number

Name of Taekwondo School

USAT Club #

Address of Taekwondo School

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Taekwondo School Phone #

- Area Code Phone Number

3. Name of Proposed Interim State President

First Name Last Name

Address of Proposed Interim State President

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Proposed Interim State President

Phone Number of Proposed Interim State President

- Area Code Phone Number

USAT Member # of Proposed President

4. Name of Proposed Interim State Vice President

First Name Last Name

Address of Proposed Interim State Vice President

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Proposed Interim State Vice President

Phone Number of Proposed Interim State Vice President

- Area Code Phone Number

USAT Member # of Proposed Vice President

First Name Last Name

5. Name of Proposed Interim State Secretary

First Name Last Name

Address of Proposed Interim State Secretary

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Proposed Interim State Secretary

Phone Number of Proposed Interim State Secretary

- Area Code Phone Number

USAT Member # of Proposed State Secretary

First Name Last Name

6. Name of Proposed Interim State Treasurer

First Name Last Name

Address of Proposed Interim State Treasurer

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Proposed Interim State Treasurer

Phone Number of Proposed Interim State Treasurer

- Area Code Phone Number

USAT Member # of Proposed State Treasurer

First Name Last Name

I have read the documents: "Establishing a USAT-MAC State Association" and "State Governance Guidelines"

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