Passport name:
given name
surname
middle name
Nationality:
Spoken language:

Fight style:
Gym name:

Manager:
tel/fax:

Place of birth:
city
state
country

Date of birth

date month year/ age

Blood type

A B O AB

Height

' " (cm)

Weight

lbs. (kg)

Postal address
tel

Marital status

married single

Occupation:

Past entry into Japan:

no ; if YES,times last entrymonthyear

Fight records in Japan:

datemonthyear hall name event name opponent result win loss draw by round

Professional debut:

datemonthyear hall name event name opponent result win loss draw by round

Most recent fight:

datemonthyear hall name event name opponent result win loss draw by round

Length as a fighter: fight style

year(s) month(s)

Title:

name wt. class since month year name wt. class since month year name wt. class since month year

Fight records:

fight style matches win (KO) loss draw fight style matches win (KO) loss draw fight style matches win (KO) loss draw

Your best techniques:

Posture:

orthodox southpaw both

training hours:

hour(s) per day/ hour(s) per week

Sports experience:

Other martial arts experience:

fight style year(s) month(s) fight style year(s) month(s)

Fighters you most respect:

Your resolution and any message out for fans:

Please send me the following materials to the mailing address to judge your skill and to know if you are ready to compete in our events.
Thank you.

a) Fighter Profile *Please see the above form and fill out all blanks completely.
b) color photos(shirtless, fight pose, chest-shot, head-shot, etc.)
c) recent fight VHS videotape or DVD
d) one(1) valid passport photocopy
e) four(4) passport sized photos

World Pancrase Create, Inc.
Attn: Ms. Mayumi Yamamoto
4-2-25 Minami Azabu, Minato-ku,Tokyo 106-0047 Japan
Tel: 81-3-5792-7077
Fax: 81-3-5792-7080
e-mail : myamamoto@mctwist.co.jp