First Name______________________________________ Last Name________________________________________
Home Phone#_________________________________ Cell Phone #________________________________________
Amateur______________________________ or Professional____________________________
Wins_______ Losses_______ Draws_______ Wins_______ Losses_______ Draws_______
*All Professionals must also complete the Amateur section
Organization (s) fought under_______________________________________________________________________
Trainer's Name____________________________________________ Phone #________________________________
Manager's Name___________________________________________ Phone #_______________________________
Name of Gym representing__________________________________________________________________________
I, the undersigned do here by voluntarily submit my application for membership in the Professional Kickboxing Federation (PKF) and understand that I am participating in a FULL CONTACT SPORT. I assume full responsibility for any and all damages, injuries and losses that I may sustain while participating in a PKF championship. I also waive all claims against any and all persons and groups associated with the Professional Kickboxing Federation, sponsors and sanctioning organizations.
I understand that any medical treatment given me will be of first-aid type only. I consent that any pictures furnished by me or any picture taken of me in connection with PKF Championships can be used for publicity, promotion or television showing and I waive compensation in regard thereto.
I also certify that I will read, or have read the PKF Championship contestant and registration rules, and will abide by its rules and interpretation of these as outlined by the promoter or his agents.
APPLICANTS SIGNATURE IF UNDER 21 Yrs OF AGE PARENT OR GUARDIAN SIGNATURE
DATE APPLICATION SIGNED SIGNATURE OF NATARY PUBLIC
MAKE CHECK PAYABLE TO: JONAS NUNEZ JR. SEND $30.00 FEE TO
126 ELMORA AVENUE ELIZABETH NEW JERSEY 07202
(IF PAYING IN CASH PLEASE DO SO IN PERSON DO NOT MAIL)