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September 17th, 2005 - Macon Georgia

Age ______________
Address_______________________________________________________________________ _____________________________________
Phone ___________________________
Email _______________________________________
Height ___________________ Present Weight ______ Weight Division Entered_____________
School _______________________________________________________________________
School Address ________________________________________________________________

Amateur Record
MMA Record _____ W _____L _____D
Boxing Record _____ W _____L _____D
Kickboxing Record _____W _____L _____D

Professional Record
MMA Record _____ W _____ L _____D
Boxing Record _____ W _____L _____D
Kickboxing Record _____W _____L _____D


Please check one

Four Man Tournament ____ Single Bout_____ Either______

The Tournament matches shall consist of three (3) rounds, each of four (4) minutes in length, with a one (1) minute rest between each round.
The tournament will consist of a 4 man elimination bracket and and alternate fighter in case of disqualification or injury.

Weight Classes first come first serve:
135 under
145 under
155 under
170 under
185 under
205 under
265 under
265.1 and up

*Please note there is a $20.00 processing and registration fee to officially hold your spot in this event that needs to be sent in WITH this application.
This fee will also include a pass for two corner men.

Mail applications to:
Matthew Waller
2947 Crestline Drive
Macon, GA 31204