UNITED STATES NATIONAL CHAMPIONSHIPS SERIES

USMTA the Official governing organization for American Muay Thai

Official member of the WAMTO, WMTC, WMTF, AMTAT

OFFICIAL MUAY THAI - FIGHTERS REGISTRATION FORM I

Name:________________________________ Last Name:______________________________

Address:_____________________________ _________________________________________

City:________________________________ Street____________________________________

State:__________________ City:_________________________ P. Code:_________________

                     Personal Information

 Color of hair: ________________________ 

Color of Eyes:_______________________ 

Blood Group : (if known) _____________

Birth Marks (if any) :__________________

 Tattoo's: (if any): ____________________

               Professional Information

 Telephone( work) :______________________

 Telephone: (home): _____________________

Email Address: ( 1 ) ______________________

Email Address: ( 2 )_______________________

Internet Address: (if any):__________________ 

 (please pin photo's on this page)

PASSPORT PHOTO'S (  2 ) 

   CHECK LIST OF ITEMS TO BE SENT 

A.) Two Passport sized photo's

B.) Video of training etc. last bout 

C.) Short bio on yourself

D.) Check Money Order for $12.00

   Signed by: ________________________________ Dated: _____________________________

NOTE * Please note, fighters photographs and videos cannot be returned, The $15 dollar registration fee is non refundable. all retained information will be used for  database and  website information and  other promoters

UNITED STATES NATIONAL CHAMPIONSHIPS SERIES

USMTA the Official governing organization for American Muay Thai

Official member of the WAMTO, WMTC, WMTF, AMTAT

OFFICIAL MUAY THAI - FIGHTERS REGISTRATION FORM II

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

Name of Gym/Camp:___________________________________________________________

Address:______________________________________________________________________

City:________________________________ Street____________________________________

State:__________________ City:__________________________ P.Code:_________________

Trainer / Coach: _______________________________________________________________

Association/Organization: ______________________________________________________

          Amateur  Record (Muay Thai only)

          WIN: _______ DRAW: ________ LOSS:______

    National:______________________________

    Regional:_____________________________

    State:________________________________

    Inter-Continental:_______________________

    International:__________________________

    World:________________________________

     Professional Record (Muay Thai only)

            WIN: _______ DRAW: ________ LOSS:______

    National:______________________________

    Regional:_____________________________

    State:________________________________

    Inter-Continental:_______________________

    International:__________________________

    World:________________________________

Office use only:                                         Registration 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 fighters must abide by the rules and regulations of the USMTA By completing this form I have agreed to come under the protection of the USMTA and will pay the standard $12 dollar registration fee.

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Copyright 1998 USMTA Inc.   All rights reserved. Revised: October 16, 2004 .