USSSA Club Membership Registration

Taekwondo

CLUB MEMBERSHIP	* Are all required fields.
Club Membership Fee:	$50.00 (Membership runs from August 1 through July 31.)
CLUB INFORMATION
* Email Address:	___________________________________________________________
* Club Owner Name:	_______________________________________________________________
* Club or School Name:	_______________________________________________________________
*Mailing Address:	_______________________________________________________________
* City:	_______________________________________________________________
* State:	_______________________________________________________________
* Zip Code:	_______________________________________________________________
* Physical Location Address:	_______________________________________________________________
* School Phone:	_______________________________________________________________
* Home Phone:	_______________________________________________________________
* Cell Phone:	_______________________________________________________________
* Date of Birth:	_______________________________________________________________
Your Rank:	_______________________________________________________________
Rank Certified Through: (Select all that apply)	AAU CTF Kukkiwon United Tang Soo Do ATA AMA Other
I am interested in: (Select all that apply)	Dan Certification for My Students Dan Certification for Myself Competition Instructor Certification Hosting Events State Director Position Tournament Director Position

USSSA MEMBERSHIP CODE

I agree to be bound by the USSSA Membership Code as well as all USSSA operating procedures and policies, including but not limited to: Binding arbitration and the release and indemnity of the USSSA. By paying my annual membership dues, I certify that I have never been convicted of any sex offense nor felony; or, if so, I must apply for membership (and receive approval) through the USSSA National Office. I further certify that this membership application is correct in every material aspect, including but not limited to my (street) address and birth date.

All memberships are subject to approval by the National Committee and National USSSA Board. In the event of a rejection a full refund is available. Membership runs from September 1 through August 31.

* I understand and agree to be bound by the USSSA membership code. (Electronic signatures are legally binding.)

No refunds are issued for membership once accepted.