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Records & Ratings (Mens / Womens Division)

Snr [      ] Jnr [      ] Age___ Height___ Weight:(      lbs -     lbs) -   (      Kgs -     Kgs)

Name:____________________________ Gym/Camp:____________________________

Address:_____________________________   Street:____________________________ 

City:___________________________ State:______________   P.Code______________

Home Telephone: (      )_______________    Telephone: (       )_____________________

Contact: ________________________                 Fax: (        )_____________________

Trainer/Coach:____________________  Member of:_____________________________

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

Signature:__________________________        Date:__________________________                                 

TITLES (if any)

Professional Record (Muay Thai only)

WIN: ____   DRAW :____  LOSS:____

National:_______________________   Regional:_________________________

State:_________________________    Inter-Continental:__________________

International:___________________    World:___________________________

Office use only:           

   USMTA MEMBERSHIP No.________________________

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 form I have agreed to come under the protection of the USMTA and will pay the annual fees as so stated on my Official Muay Thai Fighters License Agreement of which I have signed.

Copyright Protected -2008 USMTA. Inc.  All rights reserved.

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Copyright Protected 1993 -2009 Trade Mark Protected 1993 -2009 USMTA. Inc. All rights reserved.