Register your interest
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Email *
Legal name (First name and surname) *
Preferred name (only if different to legal name)
Date of Birth *
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Gender *
Mobile number *
Suburb *
Which Gym? *
Are you currently at a member at this gym? *
Current weight (kg) *
Estimated final weight (kg) *
Height (cm) *
Stance *
Prior combat experience? *
If yes, please list disciplines and record
Emergency Contact  (name - relationship - mobile number) *
I commit to sell a minimum of 1 Table of 10 or 25 General Admission tickets to the fight night, 3 weeks prior. I understand that should I fail to do this I will be charged for 25 General Admission tickets  *
I commit to be at training at least 4 times per week unless otherwise agreed with my coach *
Any additional info you'd like to share
A copy of your responses will be emailed to the address you provided.
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