Application Form

PERSONAL INFORMATION

Full Name*

Age*

Sex

Male
Female

Weight (kg)*

Height (cm)*

T-Shirt and Shorts Size (Training/Gym Clothes)

Mobile Number*

Email*

Postal Address

Do you know anyone who has competed in the PCR before?

Do you have a sponsor or are you able to self finance?

Yes
No

Who is your sponsor (if applicable)

ADDITIONAL COMMENTS

MEDICAL HISTORY

Do you have any other underlying medical conditions, physical injuries or take ongoing medication? If yes, please specify:

Yes
No

Specify

Do you have private health insurance (for mouthguard - gap payment )

Yes
No

EMERGENCY CONTACT

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

I give permission for the GOBSMACKED PERTH CORPORATE RUMBLE to use my image for the events marketing strategy. I understand boxing is a contact and combat sport and I will do my best to listen to my trainers to help provide a safe boxing environment for myself and my fellow boxers. I understand the GOBSMACKED PERTH CORPORATE RUMBLE is a white collar boxing event and I will comply with the rules and regulations to keep the environment during training and the event fun, friendly and safe.

I Accept

Signature

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BOXER APPLICATION FORM