Grand Prix Application Form

Important:

By submitting this application, you confirm that you are available and committed to compete if selected. Applications may only be withdrawn for valid unforeseen circumstances with supporting documentation. Unjustified withdrawals may result in penalties in accordance with the WKU K1 SA Rules and Regulations.
Competitor Details
Name and Surname
Club / Gym Name
Instructor's Contact Number
Gender
Your Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Your Current Age
Your Contact Number
Weight Division
Choose A Weight Class Below
Enter the actual weight bracket (e.g. 60-65)
Upload a photo of the scale screen, clearly showing your current walk-around weight.

Cancelof
Do you declare that the above photo of the scale screen is your current weight?
Additional Details
Your Current Full Contact Fight Record (Kickboxing and Muaythai combined)
Have you won any titles or championships?
List your titles and achievements here:
Have you had any professional fights before?
In which combat sport did you have professional fights?
What is your current professional fight record?
Do you declare that your instructor has approved your entry?
Important: All athletes need the following:

• An active athlete membership with WKU K1 SA.

• WKU Annual Medical Form (Valid for 12 months).

• HIV, HepB and HepC tests within 6 months.

• Dental Brace Form (if applicable).
Authorization
I hereby declare that the information provided above is true and accurate, and I authorize the verification of the information submitted on this entry form. I further confirm that I have completed this entry form with my instructor’s permission, and I understand that if any of the information provided above is found to be false or misleading, I may be subject to fines, suspension, or other disciplinary action as outlined in the Amateur Rulebook.

I agree to notify WKU K1 SA if any of the information provided is no longer valid. I also agree that WKU K1 SA may retain my information on record and use them to fulfil their administrative and regulatory obligations.
Competitor's Signature (Parent/Guardian Signature for U/18's)
Should be Empty:

Competitor Details

Weight Division

Additional Details

Authorization