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Name

First Name

Last Name

Email

Phone

(###)

###

####

Academy

Gender

Male or Female (We respect everyone's view. In order to compete and follow the athletic commission, please list biological gender, thank you)

Date of Birth

11.05.1990

Age

22 yrs

Height

5'8

Walk Around Weight

Fight Weight

All Professional Bouts

5-2 MT, 1-0 BX, 2-2 MMA

All Amateur Bouts

5-2 MT, 1-0 BX, 2-2 MMA

All Semi-Contact Exp

7 MDLs, 10 PKB/PMTs, 4 TaeKwonDo