Official

IKF OFFICIALS LICENSE CARD REGISTRATION
If you can prove that you have already been an IKF Official on an IKF Sanctioned Event please list when and where below. Please include your yearly fee of $20.00 with this form and mail to: IKF P.O. Box 1205, Newcastle, CA, 95658, USA PLEASE "PRINT" NEATLY

Your Name: ___________________________________________________
Your Physical Address. _______________________________________________________________
City: _________________________ State: _________ Country: __________ Zip/Postal Code: ______________
Your Phone Number. (______) ________-_____________ (This number will be posted by your name on the Officials Page)
Your Age: _______ Date Of Birth: _____/____/_____
What IKF Promoters (If Any) have you worked for as an event Official?
- Name:____________________________ Location: _________________ Official: _______________
- Name:____________________________ Location: _________________ Official: _______________
- Name:____________________________ Location: _________________ Official: _______________
What Type Of An Official Are You?
- _____ JUDGE
  - What Rule Style(s) are you Experienced In: ____FCR ____IR ____MTR ____SS
    - _____ NONE - Need Certification Information
- _____ REFEREE
  - IF SO: What Rule Style(s) are you Experienced In: ____FCR ____IR ____MTR ____SS
    - _____ NONE - Need Certification Information
- _____ KICK JUDGE
  - Have you ever been a Kick Judge Before: _____ YES _____ NO
  - If Yes, Please list where: _________________________________________________
Your Training Background In Kickboxing, Certification Seminars Etc.. (Use back if necessary)
- _______________________________________________________
- _______________________________________________________
- _______________________________________________________
Your PAST EXPERIENCE as a Kickboxing Official. (Use back if necessary)
- _______________________________________________________
- _______________________________________________________
- _______________________________________________________
Please List for us 3 References (Name, Address & Contact info - Phone & or e-mail) to Assure that YOU are in Good Standing in Your Community as a True and Credible Kickboxing Official and have always acted in the best interest of the sport of kickboxing and others as well.
1. _______________________________________________________
2. _______________________________________________________
3. _______________________________________________________

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