When

Monday, April 17, 2017 at 8:00 PM EDT
-to-
Tuesday, April 16, 2019 at 8:00 PM EDT

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Where

This is an online event.

Contact

Ralph Bergamo
United States and World Breaking Association
203-444-4322
events@usbawba.com

USBA/WBA Membership and Renewal

Become a member of the leading Martial Art's Breaking Association in the World.

* Required information

Member Info

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  • Fee

    Type Fee
    $90.00
    $135.00
    $55.00
    $100.00

Rank, Style, Weight

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Studio Information

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  • Are you an instructor?

Emergency Contact Information

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Signature and Release

  • RELEASE: I hereby submit my Membership Application to the United States & World Breaking Association (USBA/WBA). I agree to save & hold harmless USBA llc, its founders, officers, directors, promoters, agents, members & employees from any & all liability resulting from injuries to myself or any person, or for damages to or loss of property owned or controlled by me. I fully understand & shall adhere to all USBA/WBA rules & regulations currently in place or added in the future. I fully understand the risks involved in Martial Arts Breaking & assume all responsibility for my participation in any USBA/WBA Sanctioned or Affiliated Event. I understand that membership in the USBA/WBA is upon approval by the founders & directors of the USBA/WBA, & that my membership may be denied or revoked at their discretion (any funds paid will be prorated). I release all rights to photo & video in the possession of the USBA/WBA, in which I may be the subject or in the background, to USBA llc for promotion without compensation.

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  • ***IF PAYING BY CHECK- Please print a copy of your membership application and mail to: USBA/WBA c/o Cheshire Martial Arts Ref: Membership 460 West Main Street Cheshire, CT 06410

$9,999.99

Payment

Payment Method

  • Please make check payable to:
    USBA llc
    460 West Main Street
    Cheshire, CT 06410

Payment Summary


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