To be
considered
for a
match up
on
future
fight
cards,
amateur
and
professional
practioners
wishing
to
compete
in
Boxing,
Muay
Thai,
MMA or
Grappling
should
submit
their
information
below
Competitor Information
**You must be over 13 years of age before submitting any
information.**
(* - Required)
* Last
Name:
* Street
Address:
* City:
* State:
* Zip:
* Country:
* Phone:
* Email:
* Weight:
* Height:
Date of Birth (mm/dd/yyyy):
* Gender:
Do you have a current passport?
If yes, please enter the
country for which the passport is valid:
Do you have health insurance?
Gym:
Trainer:
Gym
Address:
City:
State:
Zip:
Country:
Gym Phone:
Gym Email:
Gym Fax:
How long
have you been with this gym?:
How long
have you studied martial arts?:
Fight Experience
Current
Status:
Boxing
Record:
Muay Thai
Record:
Kickboxing
(Low-Kick) Record:
Full
Contact Record:
Mixed
Martial Arts Record:
Submission
Grappling Record:
List titles
and date won:
Professional Record:
Boxing
Record:
Muay Thai
Record:
Kickboxing
(Low-Kick) Record:
Full
Contact Record:
Mixed
Martial Arts Record:
Submission
Grappling Record:
List titles
and date won:
List last 3 fights:
(Date, Event, Location, Result)
Have you
fought for the CSC before? If so, please list
the event, location, and date:
Yes
No
Additional Information:
**You must be over 13 years of age
before submitting any information.**
**Please verify all
information is correct. We will be unable to contact you if
any of the information is not valid.**
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