Optional Headgear Application

IKF AMATEUR OPTIONAL HEADGEAR APPLICATION Fighters Name: ________________________________ AGE: _____ Fight Record: _____-____-___/_____ - Proposed Bout Date: ___/___/___ Promoter: _________________ - Event Location: __________________
Fighter, Please list the following information of your Last 5 Amateur "Kickboxing" bouts. PLEASE PRINT NEATLY If we cannot read any portion of your information, such fight will not be counted and your application denied.
#	Opponents Name	Promoters Name	Promoters Phone Number and or e-mail	Bout Was Sanctioned By	Did You Win or Lose	How Win Or Lose Dec, KO?	Month & Year Of Bout
1	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
2	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
3	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
4	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
5	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
6	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
7	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
8	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
9	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
10	_____________ _____________	_____________ _____________	(_____) _____________	______	______	______	___/_____
IF the Trainer/Fighter submit a falsified background to the Promoter and discovered by the IKF PRIOR to the event, the fighter will not be allowed to fight on the proposed event. As a Penalty for doing so, the Trainer and or Fighter will be fined and suspended as follows: Trainer: $1,000.00 Fine, 3 Month Suspension from Being a Second/Cornerman on an IKF Sanctioned Event. Fighter: $500.00 Fine, 3 Month Suspension from Fighting on an IKF Sanctioned Event. IF the Trainer/Fighter submit a falsified background to the Promoter and it is discovered by the IKF AFTER the fight takes place, as a Penalty for doing so, the Trainer and Fighter will be fined and suspended as follows: Trainer: $1,500.00 Fine, 6 Month Suspension from Being a Second/Cornerman on an IKF Sanctioned Event.. Fighter: $1,000.00 Fine, 6 Month Suspension from Fighting on an IKF Sanctioned Event. I/We hereby declare that I/We have truthfully listed the last 10 Amateur Kickboxing Bouts of the Amateur Fighter listed above in detail and that I/We fully understand the meaning and importance of these listings. I/We further declare and represent that I/We am/are at least 18 years of age, that I/We have full legal capacity to be bound by the requirements and penalties of this Application, and that I/We am signing this Proof Of Experience Application of my/our own free will and accord. Executed at _________________AM/PM, on this _________day of ____________________, in the year 20____. Fighters Signature: ____________________________________ Trainers Signature: ____________________________________