1 Membership Info2 Club Details3 Club Member Details4 Release and Waiver5 Payment and Confirmation Clubs - be they standalone facilities dedicated to Muaythai, large multi-discipline gyms dedicated to many martial arts, or small programs run in a community centre - are a place where people are transformed. Skills are learned, obstacles are overcome, friendships are made, and successes are celebrated. Each Club is its own unique community, and membership with Muaythai Canada will provide your Club with: Competition Member Clubs have access to the National Championship as well as events promoted by club owners like yourself, sanctioned by Muaythai Canada or its affiliated Provincial Sport Organizations (PSOs). International Opportunities on the National Team Muaythai Canada manages the National Muaythai Team, participating in competition affiliated with the International Federation of Muaythai Amateur (IFMA) throughout the world. The Pan Am Championship, World Championship, Youth World Championship, World Games, & World Martial Arts Mastership are only a few of the many events that the team attends. Public Club Listing MTC maintains a listing of registered Muaythai Clubs at the Club Directory. Customers looking for a Club to join can be assured that those listed follow the policies What You Need to Complete the Registration Form The club's address and contact information A primary contact for the club *A credit card to complete the annual membership payment of $100 + GST/HST. *If this is your club's first time participating in MTC competition the membership fee is deferred until your second event. Please proceed with the application as normal. Membership Duration Annual Muaythai Canada Memberships are based on the calendar year. Active memberships end on December 31st of the year of registration. This is true no matter when a club has registered. Example 1: A club registers with Muaythai Canada on September 1st, 2019. Their membership expires on December 31st, 2019. Example 2: A club registers with Muaythai Canada on February 1st, 2019. Their membership expires on December 31st, 2019. There are no refunds for the yearly membership if already processed and used. Membership Processing TimesMembership information is not processed within 1 business day of an event. The timeline to process, review, and verify submissions is five to seven (5 to 7) business days. If you are participating at an event, the submission deadline is two (2) business days before the event. If you submit information two to five (2-5) business days before your event, a Rush Fee is needed for processing. (All membership requirements must be submitted before the event, including: club membership, Medical Declaration Form, lab test results, and Vulnerable Sector/ Police Record checks.) Refer to image below for a Rush Fee Schedule: • OK - Memberships are processed without a rush fee • RUSH - Only Memberships with a rush fee are processed • NOT PROCESSED - Memberships are not processed on these days, even with rush fees • EVENT - Event day I understand that membership information submitted within 1 business day of an event will not be processed in time for competition, and that information submitted within 2 to 5 business days will be subject to a $30 rush fee.* Yes I have read, understand, and agree to the following MTC rules and policies:*Competition Rules & Regulations Code of Conduct Yes I am registering a club based in the province of...*(Please Select)ABBCMBNBNLNTNSNUONPEQCSKYTThe Muaythai Canada club Membership is only for clubs in provinces that do not have a recognized Provincial Sport Organization. Ontario clubs should visit www.muaythaiontario.org to register their club. Club InformationClub Operating Name*Your Club's operating name (e.g. York Muaythai) is what will display in the Club Directory and for athletes & coaches to select when they register with MTO.Club Legal Name*Your Club's registered legal name (e.g. York Muay Thai Inc., Ontario 12345 Ltd, etc), which may be the same as your Operating Name.Business Type*(Please Select)CorporationCo-operativePartnershipSole ProprietorshipUnregisteredDate Established*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Club Program & Facility InformationThe following will provide a better understanding of what your school offers to its members, and will be published on the club's directory listing. If there is a class, equipment, amenity, or program that is missing and should be added, please contact us.Muaythai Program Information* Select All Youth Muaythai Beginner's Muaythai Intermediate Muaythai Advanced Muaythai Sparring Competition Training Muaythai Fitness / Bootcamp Personal Training Open Gym Sessions Facility Training Equipment* Competition Ring Platform Ring Floor Ring Heavy Bags Speed Bags Uppercut Bags Freeweights / Dumbbells Weight Rack Cardio Equipment (Treadmill / Elliptical / Rowing) N/A A ring with a platform raised 3 to 4 feet, that meets competition standards.A ring with a platform raised off the floor by a small height.A ring built directly in to the floor with no raised platform.Facility Amenity Information* Wheelchair Accessible Individual Changeroom Showers Shared Changeroom Showers Changeroom Independent Showers Day Lockers Long Term Lockers Lounge Area Food / Snacks Bottled Drinks Juice / Smoothie / Protein Bar Water Fountain N/A Additional Sports & Programs* Boxing Kali Eskrima Karate Kickboxing Krav Maga Freestyle Wrestling Grappling Judo Jujitsu Meditation Movement MMA Pilates Sanshou / Sanda Strength Training Taekwondo Yoga N/A Club MediaYour club's profile image will be displayed in the club directory and will represent your brand. This could be a logo, a picture of the front of your school, a picture of a class underway. The club promo images will be displayed when someone clicks on your club's name for more details. Just make sure there is no offensive material visible, otherwise your member directory profile may not be approved. File types: .jpg, .jpeg, .png - Maximum 5MBClub Profile Image Club Promo Image 1 Club Promo Image 2 Club Contact InformationClub contact, web, and social media information will be publicly displayed in the MTC club directory.Club Email* Enter Email Confirm Email Club Phone*Club Website Club Facebook Club Instagram Club Twitter Club Youtube Club AddressClub Physical Address*Your club's physical address will be used to place your club on a map in the Club Directory listing - please ensure the address is accurate. Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Does your club have a mailing address that is different from the physical address?*YesNoClub Mailing Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Primary Contact InformationA club's primary contact will receive email updates regarding membership information, competition information, policy changes, and other administrative topics.Primary Contact Role*Select all that apply Owner Head coach Coach Athlete Admin Other Primary Contact Name* First Last Primary Contact Email* Enter Email Confirm Email Primary Contact Phone*Primary Contact Email InterestsAll members will receive email updates regarding organization wide policy changes and membership information. Please indicate any additional topics of interest below. Check all that apply. Athlete Information Coach Information Judge & Referee Information Club Information Recreational Member Information Competition Information Seminar Information Would you like to add information for a secondary contact?*YesNoSecondary Contact InformationA club's secondary contact will receive email updates regarding membership information, competition information, policy changes, and other administrative topics.Secondary Contact Role*Select all that apply Owner Head coach Coach Athlete Admin Other Secondary Contact Name* First Last Secondary Contact Email* Enter Email Confirm Email Secondary Contact Phone*Secondary Contact Email InterestsAll members will receive email updates regarding organization wide policy changes and membership information. Please indicate any additional topics of interest below. Check all that apply. Athlete Information Coach Information Judge & Referee Information Club Information Recreational Member Information Competition Information Seminar Information Club Members DetailsClub membership information is used for reporting, funding applications, and advocacy efforts. Your club’s member information will never be released on its own- only in aggregate with other clubs. The information will be used to demonstrate the economic benefits of Muaythai through reports that show market reach, market opportunity, etc. Completing the following information is extremely important, as it will unlock access to programs like the Canada Games, partnerships with the Coaching Association of Canada, Sport Canada funding for high performance athletes, and more.Coaches & Officials# Coaches*Please enter a number greater than or equal to 0.# of Technical Officials*Please enter a number greater than or equal to 0.Recreational Members# Female Youth (Under 18) Recreational Members*Please enter a number greater than or equal to 0.# Male Youth (Under 18) Recreational Members*Please enter a number greater than or equal to 0.# Female Elite (18-40) Recreational Members*Please enter a number greater than or equal to 0.# Male Elite (18-40) Recreational Members*Please enter a number greater than or equal to 0.# Female Master (41-55) Recreational Members*Please enter a number greater than or equal to 0.# Male Master (41-55) Recreational Members*Please enter a number greater than or equal to 0.Competitive Members# Female Youth (Under 18) Competitive Members*Please enter a number greater than or equal to 0.# Male Youth (Under 18) Competitive Members*Please enter a number greater than or equal to 0.# Female Elite (18-40) Competitive Members*Please enter a number greater than or equal to 0.# Male Elite (18-40) Competitive Members*Please enter a number greater than or equal to 0.# Female Master (41-55) Competitive Members*Please enter a number greater than or equal to 0.# Male Master (41-55) Competitive Members*Please enter a number greater than or equal to 0. Release and Waiver1. By signing this waiver I warrant that I have read and understood the Rules and Regulations of Muaythai Canada (MTC). I also understand and agree that any violation of any MTC policy or rule by any member of my club/school including by not limited to, an athlete, coach, instructor or a recreational member registered with MTC, will result in the suspension or termination of my membership. 2. I understand that it is my sole responsibility to renew the membership annually. Should I choose not to renew, it is my sole responsibility to inform all of the individual members of my club that they are no longer members of MTC, and that their insurance coverage under MTC is terminated. 3. I certify that the information provided in this form is true. I understand that providing false information may result in the suspension or the termination of my club’s membership. 4. By signing this waiver I agree and consent to MTC's transmission, collection, maintenance, processing, and use of this information for insurance purposes, and for marketing and supporting the advocacy efforts to promote the status of Muaythai in Canada. Apart from the purposes listed in this clause, MTC will never disclose your name or any other personal information to outside parties. Agreement to Release and Waiver* I have read and agree to the release and waiver and am an authorized representative of the club, over the age of 18 Representative's Name*Representative's Signature* Membership InformationAre any of the following true: 1) Has your club had any athletes previously compete in competition with a Muaythai Canada affiliated organization, 2) will your club be participating in this year's National Championship, 3) will you be hosting an MTC sanctioned event, or 4) do you want your club to be listed in the MTC Club Directory?*YesNoClubs are able to participate in their first Muaythai Canada affiliated event (club show's only) without paying the club membership fee. Payment of the membership fee is required should you wish to continue to participate in Muaythai events. Trial members are not able to host MTC sanctioned competition and will not be visible on the MTC Club Directory. If you would like to be listed on the directory, please select "Yes" above.Membership Fee2019 MTC Club Membership*Expires December 31st, 2019 Price: CAD$ 100.00 CAD Rush Information Processing*Rush information processing is required when submitting information 2 to 5 business days prior to an event an individual or club is participating in. Information submitted 1 business day prior to an event will not be processed. Refer to image below for a rush fee schedule: "OK" - Memberships are processed without a rush fee "RUSH" - Only Memberships with a rush fee are processed "NOT PROCESSED" - Memberships are not processed on these days, even with rush fees "EVENT" - Event day I do not need Rush Processing ($0)I need my information rushed to be processed within 5 business days ($30)Rush Information Processing Fee Price: CAD$ 30.00 CAD CouponCoupon Coupons are generally only used for administrative purposes.Payment InformationSubtotalHST (15%) Price: CAD$ 0.00 CAD HST (13%) Price: CAD$ 0.00 CAD GST (5%) Price: CAD$ 0.00 CAD Total CAD$ 0.00 CAD Billing InformationCredit Card* American ExpressDiscoverMasterCardVisaJCBMaestro Card Number Expiration Date Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name Cardholder Email* Enter Email Confirm Email Cardholder Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe This iframe contains the logic required to handle Ajax powered Gravity Forms.