Technicians Thaiboxing
Membership Form
All information provided in this document will remain private and confidential
Member’s Name
*
First Name
Last Name
Pronouns
Gender
*
Male
Female
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
Do you have any previous experience in Muay Thai
*
Yes
No
Some
Please list any medical concerns / injuries that may impact your Muay Thai training
*
Please list any allergies
Does the member consent to being used in photographs / videos which will be posted on social media
Yes
No
Emergency contact name and number
*
Signature
*
If you have signed on behalf of a minor - please provide your full name and relation to the member
How did you hear about us?
Let us know your social media handles so we can follow and tag you in our posts/videos
Continue
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