Your Details

* denotes required fields

Name*

Email*

Mobile Phone*

Date of Birth & Current Age*

Height*

Weight Class (Please tick all that apply)

Strawweight - 115lbs/52.2kgsFlyweight - 125lbs/56.7kgsBantamweight - 135lbs/61.2kgsFeatherweight - 145lbs/65.8kgsLightweight - 155lbs/70.3kgsWelterweight - 170lbs/77.1kgsMiddleweight - 185lbs/83.9kgsLight Heavyweight - 205lbs/93.0kgsHeavyweight - 265lbs/120.2kgs

Which event are you interested in fighting in?* (Please tick all that apply)

MMARSDFC - AmateurDFC - Pro

Are you available to fight in our next event?*

—Please choose an option—YesNo

Name of your Gym

Trainer Contact Details

If you train yourself, please enter your own contact details below

Name of your Trainer*

Trainer Email Address*

Trainer Mobile Phone*

State*

—Please choose an option—South AustraliaVictoriaNew South WalesAustralian Capital TerritoryQueenslandNorthern TerritoryWestern Australia

Your Fight Record and experience

MMA

Boxing

Thaiboxing/K1

Have you been graded in BJJ?*

—Please choose an option—YesNo

If yes, what belt colour?

Have you been graded in Judo?*

—Please choose an option—YesNo

If yes, what belt colour?

How long have you been training in Martial Arts?*

—Please choose an option—Under 1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years+

Please provide any other relevant details such as any regional, state, Australian, World or other countries National Titles you may have won in ANY discipline

Other Info

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