Think you've got what it takes to participate in an upcoming CageZilla Fighting Championship event?

To be considered for an upcoming event you must fill out ALL fields below if you have not filled out this form on or after June 1, 2022!

Note: VA Law requires that all contestants, pro or amateur, have blood work and a physical or doctor's note within 180 days of your bout. See below for details and links.

First Name*

Last Name*

Height*

Reach*

Stance* (select one or more)

OrthodoxSouthpawSwitch/Both

DOB* (Date of Birth)

Gender*

Gym/School Name* (if none, write independent)

Coach's Name*

Coach's Email*

Coach's Cell Phone* Number

Your Email*

Fight Record, includes smokers* (if none, type 0-0-0)

MT/KB Record* (if none, type 0-0-0)

Boxing Record* (if none, type 0-0-0)

Ammy MMA Record* (if none, type 0-0-0)

Pro MMA Record* (if none, type 0-0-0)

Fight Weight* (select one or more)

Straw - 115lbsFly - 125lbsBantam - 135lbsFeather - 145lbsLight - 155lbsSuper Light - 165lbsWelter - 140lbsSuper Welter - 175lbsMiddle - 185lbsSuper Middle - 195lbsLight Heavt - 205lbsCruiser - 225lbsHeavy - 265lbsSuper Heavy - over 265lbs

Walking Weight* (select one or more - hold ctrl button down to select more than one)

Straw - 115lbsFly - 125lbsBantam - 135lbsFeather - 145lbsLight - 155lbsSuper Light - 165lbsWelter - 140lbsSuper Welter - 175lbsMiddle - 185lbsSuper Middle - 195lbsLight Heavt - 205lbsCruiser - 225lbsHeavy - 265lbsSuper Heavy - over 265lbs

Rule Set Options* (select one or more - hold ctrl button down to select more than one)

MMABoonchu

MMA - 4 oz gloves. In a cage. Unified rules (same as UFC)

Boonchu - 4 oz gloves. In a cage. Muay Thai Full Rules.

Time Training* (while we do accept independent registrations, you should have previous formal training in combat sports and/or high level training in other high school, college or professional sports)

Please Attach a CURRENT torso and head shot with arms folded*

To see a sample of a good pose follow this link.

(This box must be checked in order to submit this form and participate in any of our events. You may unsubscribe at any time.) By your submission, you affirm that you are at least 18 years of age or, if under 18 years of age, will have a parent or guardian's signature acknowledging permission to participate in the event and to the requirements contained within this form.

(This box must be checked in order to submit this form and participate in any of our events. You may unsubscribe at any time.) By your submission, you agree to be added to our email list and grant Thai Championship Boxing (hereinafter referred to as "TCB") and/or its parent company, Salisbury & Associates LLC, affiliates or subsidiaries permission to contact you for legitimate business reasons in association with this event or other subsequent events hosted by TCB and/or its parent company, Salisbury & Associates LLC, affiliates or subsidiaries. Your information submitted here will not be used for personal reasons and will not be sold to outside marketing agencies or other companies not directly associated with TCB and/or its parent company, Salisbury & Associates LLC, affiliates or subsidiaries but may be used for business and marketing purposes for events and/or business conducted by TCB and/or its parent company, Salisbury & Associates LLC, affiliates or subsidiaries.

(This box must be checked in order to submit this form and participate in any of our events.) By your submission, you grant Thai Championship Boxing (hereinafter referred to as "TCB") and/or its parent company, Salisbury & Associates LLC, affiliates or subsidiaries a royalty-free, world-wide, perpetual, non-exclusive license to use your likeness and display, distribute, reproduce, and create derivative works of any images submitted by you or taken of you, in whole or in part, in any media now existing or subsequently developed, for any purpose, including, but not limited to advertising and promotion of TCB and/or its parent company, affiliates or subsidiaries, and its website, exhibition, and commercial products. Any photograph reproduced or taken may include a photographer credit at photographer’s request and by permission of TCB and/or its parent company, affiliates or subsidiaries at its sole discretion. TCB and/or its parent company, affiliates or subsidiaries will not be required to pay any additional consideration or seek any additional approval in connection with such uses.

(This box must be checked in order to submit this form and participate in any of our events.) LIABILITY RELEASE Combat Sports Competition presented by Wylde Style Productions, CageZilla & TCB. Please read carefully. Each person participating, in the combat sports competition must read and accept this waiver form. You acknowledge that you are participating in a combat Sports competition, which presents a risk of serious bodily injury and/or death. You understand that because of this there is always an inherent risk of injury that cannot be eliminated. You acknowledge that Salisbury & Associates, LLC dba Wylde Style Productions, CageZilla Fighting Championship, Thai Championship Boxing and others (“Promoters”), and any of their affiliates/subsidiaries/persons connected to this event, including but not limited to Jeff Salisbury aka Jeff Wylde, Chris Salisbury, Miguel Pires, VCSS and Salisbury Hospitality Group, LLC dba The Salisbury Center in their professional and/or personal capacities cannot be held responsible or liable for any injuries, damage or loss. As a condition of being permitted to compete in this event, you, for yourself, your heirs, executors and administrators hereby waive and forebear to exercise any and all rights for claims of damages against Promoters, their officers, employees and representatives. You, for yourself, your heirs, executors and administrators knowingly and freely assume the risk of all injuries, losses and damages and do hereby hold Promoters, their officers, employees, representatives and all persons otherwise connected with this event, harmless from any and all liability (including attorney's fees and costs) for all claims, actions or damages due to injuries, losses or damage suffered by you or caused to a third party by you during the course of this event, or arising out of the activities of the event, or any other activities occurring on the premises of The Salisbury Center event facilities or elsewhere. You certify that you are in good health and conditioning and are unaware of any condition that would result in your injury or death. Any physical exam provided at this event is limited to a physical screening and not intended to provide any level of medical assurance of your ability to participate in this event. You further certify that you have submitted your blood test results showing that you am negative for HIV, Hepatitis B and Hepatitis C, you are either fully vaccinated and are two weeks or more past your final vaccination shot and/or have no signs of Covid-19, and carry your own insurance and that any insurance carried by Promoter is subordinate to your own insurance. In order to ensure your safety and the safety of the other participants, you agree to conduct yourself in a manner consistent with the rules of mixed martial arts etiquette and observe common sense safety. You certify that you have read, understand and agree to the conditions of this Liability Release.

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