FIGHTER MEMBERSHIP APPLICATION

Date: ________________________

Name: ________________________________________________________________________________________________

Please include “fighting name” or “nickname”

Address: ______________________________________________________________________________________________

                    number           street                                               city                                    state                     country             postal code

Tel: Home (______)__________________   Cell (______)____________________  Email: ___________________________

Date of birth: _______________________   Age: ____________   Sex: ___________________  Height: _________________

I will be fighting   AMATEUR  or  PROFESSIONAL  (please circle one)

I will fight any of the following styles:  FULL CONTACT   /   FREESTYLE RULE  /  ORIENTAL RULES   /   MUAY THAI   /     SAN SHOU     /   MMA

                ( please circle)                                       above the belt strikes only     leg kicks above the knees    leg kicks and knees strikes   leg kicks & knee strikes   kickboxing plus       mixed

         neck wrestling                  throws              martial arts

          & off balancing

Weight:  “I can fight from ________  lbs.  to  _______  lbs.”             “I prefer to fight at ________ lbs.

TRAINER / MANAGER INFORMATION

Name: _______________________________________________________________________________________________

Gym or Studio Name: ________________________________________________________________________

Address: ______________________________________________________________________________________________

                    number           street                                               city                                    state                     country             postal code

Tel: Home (______)___________________   Work: (______)____________________  Fax: (______)____________________