ICNZ MMA have now opened applications for ICNZ 8 which will be held on the 28th November at the Auckland Boxing Association.
If you would like to register for ICNZ 8
You can either download the ICNZ MMA Fighter Registration Form A from here and post to Neil Swailes. Alternatively you can scan the filled in registration and email it direct to neil@icnzMMA.co.nz
Or Copy and Paste the registration info below, add your details then email to neil@icnzMMA.co.nz

FIGHTER REGISTRATION FORM

NAME: _______________________________________D.O.B.____/____/_____

Surname,                                     Given Name

ADDRESS:  ___________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

PHONE: (A.H.): _______________________ (B.H.): _______________________

MOBILE: __________________ E-MAIL: ___________________________________

WEIGHT (Kgs):__________

APPLICATION TO FIGHT (please tick any/all boxes you wish to be matched under. Final say on

placement remains at the discretion of ICNZ MMA matchmakers )

□ B-Class (Open to all and geared to novice. Expense allowance granted)

□ A-Class (1 step up from B-Class. Expense allowance + $150 appearance)

□ Pro-Class (For professional level fighters only.  Expenses $250 appearance + $200 winner’s purse)

FIGHTING & TRAINING RECORD

Club/Gym: __________________________________________________________

Trainer:            _______________________________________________________

Years training:___________________ Grade attained:         ___________________

BRAZILIAN JIU JITSU (W/D/L) ____________________________________________

KICKBOXING (W/D/L)          ____________________________________________

MMA FIGHTS (W/D/L)          ____________________________________________

Comprehensive details of other combat sport training and experience:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EXCLUSION OF APPLICANT

Have you ever been excluded from any combat sport or Martial Art, in the past by a medical practitioner or any other person or entity or Martial Arts Club? _________________________

If yes give details:

PARENTAL CONSENT

(if aged under 18years this must be completed by your parent or legal guardian)

I,________________________, acting in my capacity of legal guardian/parent do hereby grant my consent for the above applicant to participate as an individual in this tournament and do hereby assume full responsibility for any and all damages, bodily injuries or losses of every kind and description that may be sustained or incurred, if any, while attending, and hold harmless the Promoters, Participants, Officials and Sponsors of ICNZ MMA. I hold, to the best of my knowledge the above information to be correct. I fully understand that any medical treatment given will be of a first aid type treatment only.

Dated this __________ day of ____________20____

Parent/Guardian Signature________________________

DECLARATION OF UNDERSTANDING

I have read and understood the terms of the ICNZ MMA, or if I did not

understand the terms I requested an independent person to explain them to me

Dated this ________________day of ___________________20_____

Applicant Signature _______________________________Date ___________

Witness Signature ________________________________Date ___________

APPLICATIONS MUST BE SUBMITTED TO…..

neil@icnzMMA.co.nz