Date of Birth: _____/_____/_____
Sex:__________________
Weight (In LBS) _______or (Kilos)
_______Height (ft/in) _______or (cm) _______
Address:_________________________________________
City: ____________________ Country:
________________ Postcode: _________________
Telephone: (___) _______________________
Fax:(___) _________________________
E-Mail: ________________@_________________
Trainers Name: (List SELF if you train
yourself)_________________________________
Gym Name:____________________________________
Contact Phone Number: _______________________
Fax: _________________________
E-Mail (If
One):________________@_________________
Amateur Fight record with KOs if any:
Kickboxing: _______Wins _______Loses
_______Draws _______ KO's/TKO'S
Boxing (If any) : _______Wins _______Loses
_______Draws _______ KO's/TKO'S
Professional Fight record:-
Kickboxing: _______Wins _______Loses
_______Draws _______ KO's/TKO'S
Boxing (If any) : _______Wins _______Loses
_______Draws _______ KO's/TKO'S
Division:
PRO________ AMATEUR:________
Full Contact Rules: ________
Kickboxing Rules: ________
Muay Thai Rules: ________
Other: ________
Last Bout Information: ( if any):
Opponents Name:
________________________________________________
Where was Bout/Event:
___________________________________________
Date of Bout/Event:_____/_____/_____
Result (W __ L __ D __ TKO __)
Other Organization, rank and title(s) IF ANY:
______________________________________
Full body photograph in fight clothes.
I understand that there is a risk of injury or
death in competing in kickboxing. I declare that I am of good
health, with no illness or disability, which may disallow me from
competing in said competitions. My Instructor, Family and Association
have given permission for me to compete in said competition. In the
event of injury, I promise not to hold my Instructor, the promoting body
or promoter, fellow competitors or any officers of WKF or its
sister groups responsible. I promise to follow the Rules & Regulations
of the WKF at all times.
