Name  (Last, First, MI)*
Address*
City*
State*
Zip*
Secondary Phone
Primary Phone*
Email*
D.O.B.*
Height*
Weight*
Record*
Do you have Private Medical Insurance?
Yes
No
Where do you train?
Fight Experience, include dates, location, promoter, & results.*
Additional information may be required prior to your participation in a sanctioned event.  By your agreement to
these terms, you agree that you have read and understand the rules and regulations of CSC and furthermore, agree
to abide by them.  Understand that any violations are to be reported the Missouri Office of Athletics.  Also agreeable
is the code of conduct for all participants.  A $25 registration fee is required before your registration is complete.

Do you agree to these terms?          YES                       NO
ALL PAYMENTS WILL NOW BE MADE ON SIGHT WITH THE CSC REPRESENTATIVE, REGISTRATION MUST
BE PAID BEFORE FIGHTER CAN COMPETE!!!
Fighter Application
If you are a fighter and have not registered with COMBAT SPORTS COMMISSION, feel free to do so here.  
Applications will not be reviewed until your registration fee is paid.  
Be sure to fill the application out completely.  Partially filled out applications will be returned to sender.  
The information helps us identify you and your record, gives us your bio to post, and how to contact
you......Don't cheat yourself.  Understand that this is just a preliminary application and not the full version.
* = required field