2023 USMRA Club Application for NEW Clubs (New Clubs ONLY)
Club Name if New Club
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 attached? 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
*
-
Month
-
Day
Year
Date
Please attach your Club By-laws here if not on file
USMRA Club Payment using PayPal
*
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USMRA Club Dues / Renewal
$
50.00
Proceed to Checkout
Office Use Only
Payment
Bylaws
Trial Requirement
3 Required Members
Should be Empty: