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UNITED STATES MUAY THAI ASSOCIATION

Return to: USMTA National Office: Suite 1K, 6535 Broadway, New York, New York. 10471

OFFICIAL MUAY THAI - FIGHTERS LICENSE FORM

Male. [      ]   Female. [      ] Age_____   Height_____    Weight:(     lbs -     lbs) - (       Kgs -      Kgs)

Name:_________________________________ Gym/Camp:________________________________

Address:___________________________________________________________________________

City:____________________________________ Street____________________________________

State:__________________P.Code_________ City:__________________P.Code:______________

Color of hair: _____________ Color of Eyes:___________ Blood Group : (if known) __________

Birth Marks (if any) :________________ Tatoos: (if any): __________________________________

                ___________________   :Amateur Division

         ___________________:Professional Division

Fighters Photograph                                _______ :Muay Chao Cherk Div.

           _______________________ :Fight Name: (if any)

The information I have stated above is to the best of my knowledge true and complete, and and I have given permission to the USMTA to forward my Records and Ratings information to registered promoters of the USMTA and affiliated organizations.

       Signature:___________________   Endorsed by: _____________________         Date:_____________

Records & Ratings Officer

 


USMTA License fee: $15 dollars per year

The United States Muay Thai Association is the official U.S. representative of the World Muay Thai Council and the Amateur Muay Thai Association of Thailand, members of the Sports Organization of Thailand, World Amateur Muay Thai Organization. All bouts fought on European soil will be under the Rules and Regulations of the EMTU. International bouts will be recognized if the competing countries are registered members of the WMTC. All USMTA members must abide by the rules and regulations of the USMTA and will uphold the rituals of respect in the true spirit of the art. By completing this Fighters License form I have agreed to come under the protection of the USMTA and will pay the annual fees as stated on this form of which I have agreed to and signed.

MAKE CHECK OR MONEY  ORDER TO C. HEYLIGER

Copyright Protected 2008 USMTA. Inc. All rights reserved.

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Copyright Protected 2009 USMTA. Inc. All rights reserved.