USAT-MAC :: USAT-MAC Club Membership

MAC Club Membership Application

Registration as*

New Member Renewal

Club Name*

Club Instructor*

Club Representative (if different from Head Instructor)*

Head Instructor USAT Membership#*

Head Instructor Dan Rank*

Club Rep USAT Membership #*

Club Rep Dan Rank*

Physical Address*

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

Mailing Address*

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

Club Phone*

- Area Code Phone Number

Club FAX

- Area Code Phone Number

Club Email*

Club Website*

Referred by (or NA):*

Rank of Referring Person

E-mail of Referring Person

CLUB LIABILITY INSURANCE

I would like information about FREE or reduced Liability & Sport Accident Insurance (Free with 35 registered USAT Athlete Members) *** If you pay more than $1000.00 a year for Club Insurance, click the box below.

I would like information about Club Insurance*

MAILING INFORMATION

I would like to receive USAT and MAC Newsletters, Bulletins, Information and Discount Information sent via e-mail.

I would like to receive Information by e-mail*

AGREEMENT

The ABOVE NAMED CLUB hereby agrees to abide by USA Taekwondo, Articles of Incorporation, Bylaws, and Code of Operations. Additionally, to respect, abide by and to enforce all decisions of the Corporation and to correctly identity itself in all advertising with respect to titles, affiliations, etc. I understand that failure to do so may result in an imposed penalty. No reproductions of the titles, word (s) or logos of USA Taekwondo or the United States Olympic Committee or the Martial Arts Commission (MAC) are permitted without the special written consent of the appropriate organization. Misuse of the names and symbols can be a violation of public law and USA Taekwondo bylaws.

The above mentioned club hereby submits this application for Club Membership with USA Taekwondo and the Martial Arts Commission (MAC). Included is one hundred and thirty-five dollars ($135.00) electronic payment for the annual dues for the first year's membership. USAT-MAC Club Membership will renew automatically each year on the date it was originally registered. Memberships are on an annual basis. There are no pro-rated refunds. Club representative must keep profile information up-to-date.

I understand there must be 35 athlete/coach/referee members registered with my club in order to receive the free liability insurance through USA Taekwondo. I understand that the $135.00 membership fee is nonrefundable and nontransferable.

I ACCEPT the Requirements*

PAYMENT

Name of Cardholder*

Purchase Club Membership*

USAT-MAC CLUB MEMBERSHIP( $135.00 USD for the first year then, $135.00 USD for each year .)

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