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Chessboxing Nation Registration
Please complete this form if you wish to be considered as a fighter for one of our events.
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Personal Information
All information will be held in accordance with CBN privacy policies.
1. First Name
*
Your answer
2. Last Name
*
Your answer
3. Email
*
Your answer
4. Mobile/Cell Phone Number
*
Your answer
5. Postal Address
Your answer
6. Date of Birth
*
MM
/
DD
/
YYYY
7. Gender
*
Your answer
About You
Our audience wants to know who you are and why you fight.
8. Nationality
*
Your answer
9. City of Birth
Your answer
10. Training out of (which gym do you train in)
Your answer
11. Job Title
Your answer
12. Job Description
Your answer
13. Hobbies and points of interest
Your answer
14. Favourite Sports Team
Your answer
15. Biography
Your answer
Fighter Information
Your statistics and measurements when fighting.
16. Ring Name (if any)
Your answer
17. Fighting Weight (kg)
*
Your answer
18. Height (cm)
*
Your answer
19. Reach (distance between the tips of your fingers when arms are outstretched in cm)
Your answer
20. Chess E.L.O. (your rating on
chess.com
)
*
Your answer
20a. Specialism (what make you a unique fighter?)
Your answer
Your Experience
We need to know what combat sport experience you have so we can match you safely.
21. Chessboxing Record (wins, losses, draws) - if any
Your answer
22. Combat Sport Experience
*
None (beginner)
Intermediate (some experience)
Experienced (considerable experience)
Amateur Level (at least one amateur fight)
Professional (at least one professional fight)
23. Which Combat Sports
*
Your answer
24. How many Chessboxing Fights
*
Your answer
25. How many Combat Sport Fights
*
Your answer
26. Fight or Sparring Video URL
*
Your answer
27. Entrance Music
Your answer
28. Entrance Music YouTube URL
Your answer
29. Chessboxing Title (if any)
Your answer
Fighter Safety Information
We need this information so that you can fight safely.
30. Pre-existing Medical Conditions (if any)
*
Your answer
31. Trainer/Corner Person
Your answer
32. Trainer/Corner Person Email
Your answer
33. Trainer/Corner Person Phone Number
Your answer
34. Emergency Contact Person
Your answer
35. Emergency Contact Person Phone Number
Your answer
Social Media Information
36. Instagram URL
Your answer
37. Facebook URL
Your answer
38. Twitter URL
Your answer
39. YouTube URL
Your answer
40. I understand and agree to all CBN policies includes injury and image waivers as well as expenses policies.
*
Yes
Required
41. Once my fight is confirmed, I will not undertake any competitive combat sport bouts within 2 months in advance of my chessboxing bout.
*
Yes
Required
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