Register for MTC 2012

Fill in the form below to register for the 2012 Amateur Muay Thai Classic
July 6, 7 & 8, 2012
July 5th - Early Bird Registration (Optional)

Early Registration Fee: January 1-March 31: $45 USD
(includes fighter's pass for entry into all areas of tournament & Fighter's Good Bag)

Registration Fee: April 1-May 31: $60 USD (Junior Girls will stay at $45)
(includes fighter's pass for entry into all areas of tournament & Fighter's Good Bag)

Late Registration Fee: June 1-June 30: $60 + $25 late fee = $85 USD
(includes fighter's pass for entry into all areas of tournament & Fighter's Good Bag)

Last Minute Registration Fee: July 1-July 6: $60 + $45 late fee = $105 USD (no exceptions!)
Registrations will be accepted until 4:59pm on Thursday, July 5th.
(includes fighter's pass for entry into all areas of tournament. Cannot guarantee availability of Fighter's Goody Bag)

NOTICE! Your registration is not final until your registration fee has been paid!
**Registration fees are non-refundable unless withdrawal is due to military deployment.**

ONLY Paid Registrations will be listed in brackets!
Your registration is NOT complete until registration fee is paid.

Steps to complete for registration:

	1- Fill in form below. Please do not leave any field blank. Use "N/A" instead of leaving it blank.
	2- Read the statements listed below the form and place your initials in each box to confirm you read it.
	3- Click the "Submit" button.
	3- After submitting form, you will be taken to a payment page. It will allow you to pay your registration fee through paypal. You do not have to have a paypal account to pay through paypal. It can be made through a credit card, debit card, or from your savings/checking account. Note: Registration will not be considered complete until payment & photo has been received. Don't lose your spot because of non-payment.
	4-Upon completion of submitting payment, please send fight photo by emailing it to the TBA-SA Administrative Office. (Please include a high resolution photo - either a fight pose, or head and shoulders. NO photos with headgear. If not submitted, you will be charged $10 at weigh ins for us to take and print your photo for your fight pass)

NOTE: It is your responsibility to keep us updated if your record changes before the day of the tournament!
If you are in the novice and go over 3 fights, you MUST contact us immediately to change divisions.

PROFESSIONAL FIGHTERS:
***If You are a Professional fighter of Muay Thai, Kickboxing, or Boxing, you cannot compete in this amateur tournament.
If you register, your registration fee will not be returned!
PROFESSIONAL MMA FIGHTERS:
If you have fought no more then 2 pro MMA fights in the past, (cannot be in the past 12 months) and are not actively seeking future pro MMA fights,
please contact us first. We will address this on a case by case basis after examining background information. If approved, you will be required to register in the Class A Division.

Please complete all of the fields in the form.

First Name:

Last Name:

Today's Date:

Please list your birth name and any names you've been known as: (used to confirm identity and record)

SSN/SIN#
(This is to verify identity, if we need to do so. Jrs do not need to complete.)

T-shirt Size:

*Age:
(as of July 5th)

Birth Date:

Sex:

Residential Country:

Mailing Address:

City:

State/Providence:

Postal Code:

Phone:

Walking Weight: lbs. (not kg!)

Height: (in Feet & Inches, i.e. 5'10")

Fighter's E-Mail Address:

TBA Affiliated?

Junior Weight Division Registering For:

Borderline cases will be placed by TBA-SA with the best interests for fairness and the health of the competitors in mind.

Adult Weight Bracket Registering For:

PLEASE double check the wt you are registering for!
Brackets may be full. Double check before registering. There may be a "transfer fee" for those asking to move up or down in weight classes after they have registered!

ALL FIGHTERS COMPLETE THIS --
Division/Class you are registering for:
*You MUST include ALL ring experience!
This includes smokers, demos, mma, non-sanctioned bouts, boxing, all combative styles, etc.)

Gym/Training Facility:

How long have you been training at this facility?
This will be confirmed w/ trainer

Gym Website:

Physical Address:

City:

State/Providence:

Postal Code:

Trainer's Name:

Phone:

Trainer's Email:

Please list all past gyms and/or trainers you have trained with: (separate names with a comma)

Fighter's Record (BE HONEST!!! If we discover you have blatantly lied, you will be disqualified!):
Muay Thai/San Shou/Kickboxing: Wins: Losses: Draws: KO's:
Smokers: Wins: Losses:    Draws:    KO's:
Boxing: Wins: Losses:    Draws:    KO's:
MMA: Wins: Losses:    Draws:    KO's:

Updating your record: It is your responsibility to update us if you have any fights (demos, exhibitions, etc) AFTER registering. Please send updated record via email in the following format: "W-L-D/KO" w/ date and promoter/opponent fought. If you fail to notify us so you can stay in a division you are no longer able to be in after your additional fight(s), you will be disqualified.

Have you fought as a professional in any combative sport:

*Please contact us, BEFORE you register, if you have fought pro MMA fights in the past and are not actively seeking future pro MMA fights. We will address this on a case by case basis after examining background information. If you register and we determine you are not eligible to fight, you will not receive a refund.

To help establish and support fighter's rankings within the TBA-SA, please list names of your past opponents, or any information you can remember about past ring experience, i.e. promoter/promotion, date, city it took place in, smokers, exhibitions, etc. :
Please list any additional information you want us to know:

Please make sure you have reported ALL of your fighting experience.
To be registered in the Novice division, you cannot have more then 3 bouts of any kind!

Optional: This section is optional, but if you could fill it out, we would greatly appreciate it!
It helps us put together demographics of the participants which some of the sponsors ask for.
Occupation: Residence: Hobbies:

*Youth will be placed into brackets according to age (8-17) as of July 4, 2012.

All winners shall receive a belt. Runners Up and below will receive medals. Each division will have 2-8 fighters. If less than 2 fighters, the registered fighter will be asked to move to another weight bracket or division. More than 8, fighter's will have the option to move up or down to another weight division or stay on as an "alternate". We will allow up to 4 Alternates in each division. Novice fighters can also register in the Class B, Class A/Open division!

RULES: ALL Junior fighters and Class B & Novice will fight Modified Muay Thai Rules (No elbows or knees to the head). Class A fighters will be allowed elbows to the head w/supplied elbow pads. No knees to the body.

Please read all of the statements below and place initials in the box to the left of the statement before submitting registration:

	I confirm my information is accurate and I have filled in the registration form above with honesty and integrity.
	I understand if it is discovered that I have listed false information in order to enter the novice division, I will be fined ($50 USD) and moved to the Class A Open Division or if I refuse to pay the fine, I will be disqualified and will receive no refund of monies paid. If it is discovered AFTER competition, any and all titles given will be removed, publicly noted, and I will be required to return medals, belts, and any other awards.
	I understand that if I am found to have intentionally supplied false information (i.e. pro/amateur status, birthdate/age, fight record) that I will be disqualified from the tournament and will not receive a refund of any monies paid.
	I understand that my spot in the bracket is NOT GUARANTEED until I have completed ALL required steps including submission of this form, payment, and fight photo. (please submit current, high resolution photo. This will be sent thru email)
	I understand if by the time I have completed all required steps and my first choice of brackets is filled up, I can move to a 'stand by' position in that bracket and will not be guaranteed a fight or I can move to another bracket/division that still has openings. At weigh ins, if a spot is available in a bracket/division better suited, I can move once all weigh ins have been completed by paying a transfer fee of $20.
	A fighter can ask to be moved into another bracket, at no charge until March 31st. After April 1st, a fighter will be allowed to move to another bracket/division if they pay a transfer fee of $20. (If we request you to move in order to fill up a bracket. No transfer fee is required.)
	Once I have paid my registration fee, if I am forced to withdraw, I forfeit any monies paid unless absence is due to military deployment. I will submit written proof by military personnel.
	If I have paid my registration fee, am listed as a 'stand by' and show up ready to fight, but I am unable to fight due to my bracket still being full, I may either choose to move to a bracket that still has an opening or I will receive a refund of my registration fee. If I am able to move, I will not be charged the 'transfer fee'.
	I understand if I fail to withdraw and do not show up ("no show") that I will receive no refund or credit for any monies paid. I will also be marked as a "No Show" on the website and all paperwork.
	No Belts/Titles will be awarded without competing in at least one fight.
	Each division is required to have at least two competitors to stay open. Please see the rules/regulations page for more information on divisions.
	Juniors- May 21st will be the date the TBA-SA event panel will begin adjusting brackets, if needed. Your trainer will be contacted to discuss possible changes to ensure you have at least one fight and everyone has sufficient time to make new weight.

I have read the above statements and understand and agree with all of them:
(Please type name of person submitting this registration, and relationship to fighter, to confirm you have read this.)
First and Last name of person submitting registration:
Relationship to Fighter:

I prefer to be contacted by in the event you have further questions.

**Please Note: Registration information does not automatically show up.
Once received it will be reviewed and then posted. Please allow 48 hours for it to post to the website. Thank you!