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UNITED STATES MARTIAL

 ARTIST ASSOCIATION

MEMBERSHIP APPLICATION

(Click Here to See the Benefits)

 Membership Desired

Select Membership Individual Membership $20.00 annual Charter Membership $50.00 annual Lifetime Membership $100.00 U.S. Currency

School Name is Required

Initial Application

Renewal Application

Renewing Membership Number

APPLICANT'S INFORMATION

First Name       

Middle Initial   

Last Name        

Date of Birth   

Address            

City                   

State                  Select State ALABAMA ARIZONA ARKANSAS ALASKA CALIFORNIA COLORADO CONNECTICUTT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISANA MAINE MARYLAND MASSACHUSETTES MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH WASHINGTON WEST VIRGINIA WISCONSIN WYOMING VERMONT VIRGINIA

Zip Code           

Country            

Phone Number 

E-Mail                

Belt Color          Select Non-rated White Yellow Gold Purple Blue Green Brown Red Black   Grade Number  Select None 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th Kyu/Dan Select None Dan/Degree Kyu/Gup/Class

Style of Martial Arts

Mail in Method of Payment:

Please Select

Personal Check      Money Order         Pay Pal

If  paying by check or money order,

please make payable to

"SGM William A. Rankin"