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: $12 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.
Click on this USMTA logo to download or open the PDF file