Battle Cage 360

Fighter Registration

*Full Name:

Hometown:

Current Age:

& Birthday (month, day & year): / /

Have you EVER been paid a purse for fighting in ANY Striking Sport (Boxing, MMA, Kickboxing):

Height in Feet & Inches: - Fight Weight in Pounds: Lbs.

P.O. Box Or Street Address:

City: State: Zip Code:

Country:

Trainers Name: (List SELF if you train yourself)

Gym Name:

*Phone Number:

Fax:

e-mail (If One):

Fighting Style:

(eg: Boxing, Judo, Jujitsu)

Fighting Level:

(eg: Blue Belt Jujitsu 5 years, Boxing 3 years)

Amateur Fight Record with KO's (If any)

NHB Bouts:

Wins Loses Draws KO's/TKO'S

Boxing or Kickboxing (if any):

Wins Loses Draws KO's/TKO'S

Professional Fight Record If a PRO

NHB Bouts:

Wins Loses Draws KO's/TKO'S

Boxing or Kickboxing (if any):

Wins Loses Draws KO's/TKO'S

Please Check the appropriate Sections Below:

DIVISION	MALE OR FEMALE	PROS	AMATEURS
PLEASE SELECT YOUR SECTION

Last Bout Information: If possible or if any:

Opponents Name:

Where was Bout/Event:

Date of Bout/Event:

/ /

Result:

(Win or Lose, dec: unanimous, split, maj., TKO, KO, Draw, etc)

Other Organization, rank and title(s) If Any: