2021 USMRA Club Application/Renewal

Club Name *

Club Name if New Club

Date of Club's most recent trial. Club must host trial every 2 years.

Month Day Year

Location of Club *

City State / Province

Zip Code

Club Contact Person *

First Name Last Name

Phone Number *

Area Code Phone Number

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

E-mail *

President of Club if not same as contact person *

First Name Last Name

Preferred form of Contact *

Phone E-mail Facebook

Club Info for USMRA website - Example: Contact Person & his/her info, location, FB page or Website, etc. *

USMRA web site can use the checked responses for USMRA Clubs web page : *

Contact person E-mail Mailing Address Phone

Club Insurance Info - If private individual/club policy, list Company, Policy number and Contact info. You MUST attach or send policy copy to the USMRA Secretary. If your club has no private insurance write "USMRA". USMRA does not provide individual club insurance. *

Club By-laws on file? New clubs must submit a copy of the Club By-Laws. *

Yes No

Names & addresses of Club members who are also current members of USMRA. At least 3 names required. Members in multiple clubs must choose PRIMARY club for accounting purposes. *

By submitting this document, this club and it's members and agents agree to abide by USMRA by-laws, USMRA Code of Conduct and policies and procedures. We also agree to notify the USMRA Secretary in writing of any by-laws, membership or event changes, as well as event incidents and procedure deviations. USMRA is committed to an anti-discrimination policy in all of its programs. Membership entitles all members in good standing to attend all USMRA sanctioned events. *

Agree

Signature: *

Date *

Date

Please attach your Club By-laws here if not on file

USMRA Club Payment using PayPal

USMRA Club Dues / Renewal $ 50.00

If paying by check/money order - $50.00 made to out to "USMRA" mail to:

Angie Leonberger, USMRA Secretary, 2406 Pixton Drive, Killeen, TX 76543

Office Use Only

Payment Bylaws Trial Requirement 3 Required Members