ASIAN INDO KICK
CHAMPIONSHIP

OFFICIAL ENTRY FORM

Athlete Enrollment

Full Name

Date of Birth

Age Category Select Age Group Sub-Junior (Under 12) Cadet(12 - 14) Junior (14 - 18) Senior (18 above) Masters (35+)

Gender Male Female Other

Weight Category

Belt Rank Color Belt I Dan Black Belt II Dan Black Belt Master Rank

Nationality / Country India Japan Thailand South Korea Others

Phone Number

Medical Conditions / Past Injuries

Complete Enrollment