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2014 INTERNATIONAL KYOKUSHIN TOURNAMENT

FULL CONTACT KARATE - MUAY THAI

– REGISTRATION FORM –

A fee of $85.00 will be due prior to participating in the tournament.
If you are under 18 please bring a copy of your birth certificate.

1. FIGHTERS Name:First: Last:
2. Date of Birth: Mo/Dy/Yr - -
3. Current Age:
4. Height and Weight: Feet: Inches
Weight:lbs.
5. FIGHTERS eEMAIL:
6. FIGHTERS MAILING Address: Street Address:
City: State/Prov: ZIP:
Country:
7. FIGHTERS Phone #:
8. Have You Ever Been Paid to Fight?
9. Ever Fought A Pro?
10. Ever Fought AS A Pro?
11. FIGHT RECORD: W=Wins, L=Loses, D=Draw, KOs: TKOs=Knockouts or Technical Knockout.

FILL IN ALL BLANKS!! - PLEASE WRITE A –0- IF NO FIGHT RECORD. CIRCLE FIGHTING STYLE.

Kyokushin: W: L: D: KOs/TKOs:

MUAY THAI: W: L: D: KOs/TKOs:
7. TRAINER: (SELF if you train yourself)

Trainers Phone:

Trainers Address: Street Address:
City: State/Prov: ZIP:
Trainer Country:

Downloadable registration form.

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