Please read the membership policies and the Constitution and Rules of USMMA prior to filling this form. Fill in as much information as possible. Once we receive your application we will then contact you for payment.

1. MEMBERSHIP CATEGORY	Select a membership category that suits you
Member Category (Mandatory field)	Family/ Affiliate Single/Adult Student Pensioner Single Pensioner Family
2. APPLICANT	Details of the main applicant
Title (Mandatory field)
Initials
First Name (Mandatory field)
Surname (Mandatory field)
3. SPOUSE	Details of the spouse (leave blank if not applicable)
Title
Initials
First Name
Surname
4. HOME ADDRESS	Home address for records which is where your newsletter and any other mail from USMAA will be posted
Street Address (Mandatory field)
Suburb (Mandatory field)
State (Mandatory field)
Post Code (Mandatory field)
Phone (Mandatory field)
Email Address (Mandatory field)
5. BUSINESS ADDRESS	Business address for our records (leave blank if not applicable)
Street Address
Suburb
State
Post Code
Phone
6. CHILDREN	Provide the following information for each child under 18 years of age. (leave blank if not applicable)
	First Name: Surname: Gender (M/F):
7. NOMINATOR	Nominator has to be a Current Financial Member of USMAA
Nominator's name (Mandatory field)
Phone (Mandatory field)
	By placing a tick and submitting this application for membership, you agree to abide by the Constitution and Rules of USMMA and confirm that you have read and understood the membership policies.