BOXER APPLICATION FORM PERSONAL INFORMATIONFull Name*Age*Sex Male Female Weight (kg)*Height (cm)*Mobile Number*Email*Postal AddressHow did you hear about PCR?Do You have a sponsor? Yes No Who is your sponsor?MEDICAL HISTORYDo you have any other underlying medical conditions, physical injuries or take ongoing medication? If yes, please specify: Yes No SpecifyEMERGENCY CONTACTEmergency Contact NameEmergency Contact RelationshipEmergency Contact PhoneI give permission for COUNTERBALANCE FITNESS, GOBSMACKED SPORTS MOUTHGUARDS and 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 SignatureUse mouse or touchscreen to sign 54495Δ
