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Energy Fight 2019 R1 報名表
主辦單位: 中國香港綜合搏擊運動總會

請於2018年12月15日前填寫以下報名表
Please submit the online application form on/before 10th Dec, 2018.

Email address *
中文姓名 Chinese Name
以身份證為準 Same as HKID
英文姓名 English Name *
以身份證為準 Same as HKID
出生日期 Date of Birth *
MM
/
DD
/
YYYY
性別 Gender *
手提電話 Mobile *
代表團體名稱 Name of Team
身份證號相片 ID Card Photo
參加組別 Division *
報名費用單據 Payment Receipt
參加賽例 Rule *
重量 Weight(kg) *
比賽往續 Fight Records *
4場或以上比賽經驗者請於「其他」選項中以格式填寫/ if you have 4 or above fight record please fill in as format :_____場/ Bouts ____勝/ W(___KO) ____負/ L ____和 /D
健康狀況 Health Declaration *
緊急聯絡人姓名 Name of Emergency Person *
緊急聯絡人電話 Emergency Contact *
本人同意此聲明,上述資料皆確實無誤,本人明白上述資料將記錄於MCSF資料庫內,如有虛假,則將被取消申請或參賽資格,並同時作出聲明,如本人因健康、體能、個人技術或其他原因所導致的任何傷亡,概由本人負責,與主辦單位無關。I certify that the information contained above is correct, and complete to the best of my knowledge and belief. In completing this form I understand that if I wilfully give false information or withhold any material information, it will lead to disqualification for the competition. Information provided will be recorded in MCSF database. I shall take full responsibility for any injury or death which may sustain/ arise directly or indirectly as a result of this activity. *
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