IKF Title Qualification Info Form

IKF Title Qualification Info Form
To see what IKF Title(s) you qualify for (Pro or Amateur) please Inform the IKF of your fighter background so the IKF can confirm your claimed bouts, opponents and fight record. Print out this form & Fax to the IKF (916) 663-4510.

PLEASE PRINT NEATLY

Full Name:_______________________________________
Fight Weight: ________ - Height:____'____"
Current Age: ______ & Birthday (month, day & year): _____/_____/_____
City: _______________________ State: _____________ Zip Code: __________________
Country:________________________________
Trainers Name: (List SELF if you train yourself)_________________________________
Contact Phone Number: _______________________
e-Mail (If One):________________@_________________
Amateur Fight record with KOs if any:
Kickboxing: _____Wins _____Loses _____Draws _____ KO's/TKO'S
Profession Fight record If a PRO.
Kickboxing: _____Wins _____Loses _____Draws _____ KO's/TKO'S
I certify the above Is true and I confirm so by my signature here:________________________, Date: ___/___/___

WHEN GIVEN A CHOICE PLEASE CIRCLE CORRECT INFORMATION ABOUT THE BOUT DETAILED FOR RULE STYLE WRITE: Full Contact: FCR - International: IR - Muay Thai: MTR - San Shou: SS
LAST BOUTS	PRO AMATEUR	BOUT RULE STYLE	BOUT DATE	BOUT OPPONENT	BOUT LOCATION EVENT PROMOTER	BOUT RESULT	BOUT WEIGHT
1	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
2	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
3	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
4	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
5	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
6	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
7	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
8	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
9	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______
10	PRO AMATEUR	______	___/___/___	__________________	__________________ __________________	W - L D - NC	______