Athletic Commission Contestant License Application

Contestant Form

Welcome to the online payment system for the Kansas Athletic Commission. This form is for contestants, AMMA and Seconds.

License Type

Please select which of the following licenses you are applying for.

 
 
 
Name and Address Information
Required Field
Required Field
Required Field
Required Field
Required Field
Required Field
Contact Information
Required Field example: 555-555-5555
example: 555-555-5555
Required Field
License Information

Please choose which type of contestant you are: Boxing, Kickboxing, MMA or Amateur MMA and type it in the box below.

Required Field
example: 08-13-11
Additional Information

When indicating height, please enter the information as follows: 5 feet 10 inches.

Required Field
example: 11-23-10
Required Field format: MM/DD/YYYY
Convictions

Have you ever been convicted of a crime (except minor traffic violations)? If yes, please list them in the area below.

 
 
List of Convictions
 
Disciplinary Actions

Have you ever been suspended or disciplined by the Kansas Athletic Commission or any Athletic Commission?

 
 
Current Suspensions

Are you currently under suspension or revocation from another Athletic Commission?

 
 
Legal Disclaimer

I hereby certify and attest that all of the information provided herein is true and accurate. I acknowledge the right of the Kansas Athletic Commission to verify this information and take appropriate legal action if such information is deemed false or misleading.

 
Fighter Disclaimer

For boxing, amateur kickboxing and full contact karate and professional mixed martial arts:

Contestant voluntarily and knowingly agrees to participate in a kickboxing, karate or mixed martial arts event. These activities are dangerous. Contestant hereby acknowledges he/she may suffer permanent physical injuries from these events, either in a single event or from participating in multiple events. Contestant hereby releases the promoter and State of Kansas, or any agent, representative or employee thereof, from any and all claims of liability, known or unknown at this time, arising from injuries, mental and physical, which may be sustained by contestant during participation in any of these events.

 
Payment Information
Required Field required