Athlete Registration

Name

First Name

Last Name

Phone

Academy/Gym

Gender

Male or Female (We respect everyone's view. In order to compete and follow the athletic commission, please list biological gender, thank you)

Date of Birth

i.e. 11.05.1990

Age

i.e. 22 yrs

Height

i.e. 5'9

Walk Around Weight

i.e. 137 lbs

Fight Weight

i.e. 132 lbs

All Professional Bouts

i.e. N/A or 5-2 MT, 1-0 BX, 2-2 MMA

All Amateur Bouts

5-2 MT, 1-0 BX, 2-2 MMA

All Semi-Contact Exp

7 MDLs, 10 PKB/PMTs, 4 TaeKwonDo