FIGHTER APPLICATION

Fields marked (*) are required.

If you are submitting your information to participate in an up coming scheduled event, please check

Bio:

Name* Nickname

Birthdate* Age*

City, State which you train

Team Association Fighting style

Statistics:

Height* Weight* Reach* (Figer tips to figer tips across back)

MMA Record:

Pro or Amatuer* Pro Amatuer

Wins* Wins by Knockout* Wins by Submission*

Losses* Draws*

Personal Info (This will be kept confidential):

Address* City* State* Zip Code*

Phone Number* Cell Email

Representative / Manager name

Rep's Address Rep's City Rep's State Rep's Zip

Rep's Phone Number Rep's Cell Rep's Email

Submit a publicity still / photo

I agree to grant UMMAXX / Maximus Production the right to use the result of any photographic or sound recording services

which I provide, or they create. This may include, but not limited to any part of the following; radio, video, online, television

commercials or still reproduction. I also agree to hold harmless the above mentioned enterprise, it’s officers, agents and

employees acting within the scope of their official duties against liability of proprietary rights, copyrights or right of privacy

arriving out of reproduction, use or disposition of any copyrightable material furnished, or based upon libelous or unlawful

matter contained in said material. I am 18 year of age or older and fully understand these terms and conditions and offer my

full consent.

I Agree*

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