American Muay Thai Fighters, you can complete this form and submit this with your data to be added to the National Fighters Database for free!
In preparation for U.S. National Muay Thai Championships...
YOU MUST ENTER YOUR NAME AND ADDRESS IN THE SPACE BELOW:
Amateur League Professional League
Your Weight Division
Click one time on your appropriate weight, and then continue to the next section.
108 lb Junior Flyweight112 lb Flyweight115 Junior Bantamweight11 lb Bantamweight122 lb Junior featherweight126 lb Featherweight130 lb Junior Lightweight135 lb Lightweight140 lb Junior Welterweight147 lb Welterweight154 lb Junior Middleweight160 lb Middleweight168 lb Super Middleweight175 lb Light Heavyweight190 lb Cruiserweightover 190 lb Heavyweight
Age: Height: Color of hair:
Color of Eyes: (optional) Blood Group:
FIGHT RECORD AS OF JANUARY 2007
Wins: Loss: Draws: Draws: Total:
YOUR CHAMPIONSHIP STATUS
Click One Time on your appropriate Championship below, and then continue to the next section.YOUR CHAMPIONSHIP
Click One Time on your appropriate Championship below, and then continue to the next section.
YOUR CHAMPIONSHIP
StateTri StateRegionalMid West DivisionCentral DivisionEastern DivisionWestern DivisionU.S. National ChampInter-Continental ChampWorld ChampionPacific Region ChampionEuropean ChampionEastern European ChampionCanadian ChampionSouth American ChampionForeign National ChampionOther Champion:
Note* ( if you have more than one title listed above, enter this below)
PLEASE COMPLETE THIS SECTION
SCHOOL/CAMP NAME
INSTRUCTOR/TRAINER
AFFILIATION (IF ANY)
(you must enter school mailing address, otherwise your info cannot be completed)
School Mailing Address:
WILL YOU SEND A PHOTO ? YES NO
DO YOU WANT US TO RETURN THE PHOTO ? YES NO
DO YOU WISH TO RECEIVE ANY OF THE BELOW LISTED ITEMS ?
( Please make sure you have written your Address in the box above)
USMTA INFO PACK USMTA CERTIFICATE OF RECOGNITION USMTA PATCH
(Free!!) ($3.00@) ($5.00@)
LAMINATED FIGHTER REGISTRATION CARD FULL USMTA MEMBERSHIP PACK
(Free with registration fee $12.00 Needs Photo) Standard ($20.00) International ($45.00)
Tell us how to get in touch with you:
(you must enter your email address)
Your E-mail Your Tel Your FAX
Please contact me as soon as possible regarding this matter.
Please check this list to see that your address is written in and your school/camp name is included, for us to return any information to you:
For purchase of items above, please make check or money order to: USMTA (Reg. Dept), Suite 1K, 6535 Broadway, Riverdale, NY 10471 USAPlease re-check to see that you have entered your mailing address, email and your correct Amateur or Professional division
For purchase of items above, please make check or money order to: USMTA (Reg. Dept), Suite 1K, 6535 Broadway, Riverdale, NY 10471 USA
THANK YOU