Please provide accurate information for the fighter who will receive this license. The license must be renewed every calendar year except for those purchased in December - these will be valid until the following December. If any information on this form is deemed to be falsely submitted, the fighter and or coach may be suspended from the WKA for up to a year. There are NO refunds! If you purchase a license but do not compete we will NOT refund your license fee. You will receive your license at the email address provided below. Your license will be emailed once payment has been received. All Information below is for the fighter receiving the WKA Fighter's License Fighter's Name (First Name / Last Name): Fighter's Date of Birth: - - Choose One - - Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec - - Choose One - - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- -- 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Fighter's Email Address: Amateur ($25) or Professional ($30) License? Select One Amateur Professional