Amateur Fighter Registration Form

To register to fight in one of our events, you must complete the following form online or you can download the form in PDF format. The form must be completely filled out and returned to Pahlavan Fight Promotions C/O Ali Tareh , 6240 39th Street N, Pinellas Park, FL 33781, USA.

Name

First Name

Last Name

Middle Initial

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Date of Birth

YYYY

Gender

Weight Class

Fight Style (Check All that Apply)

Boxing

Kickboxing

MMA

Walking Weight

Height

List Amateur Sport Records

Years of Fight Training

ex: 10 years

Gym / School Name

List Trainer's Name/s

Who will corner your fight?

Medical Notes:

Fighters older than 35 years of age need to get an EKG Test and a doctor's note.

Fighters older than 40 years need to have MRI test results.

MMA Fighters Require:

HEP C Antibody Test
HEP B Surface Antigen Test
HIV
Eye Exam

All 4 should be renewed every 12 months.