1 Event Host Responsibilities2 Promoter Information3 Event Information4 Event Performance Information5 Payment, Release, and Waiver Thank you for your interest in hosting a Muaythai Canada sanctioned event. As an Event Host you must review all policies, code of conduct and regulations regarding Muaythai Canada competition. The promoter must be a provincial or federal registered business in Canada. A promoter must be a resident of Canada A promoter must be a member in good standing with Muaythai Canada All rules and regulations governed by Muaythai Canada will be enforced. A promoter must pay all prescribed fees including officials and medical staff. A promoter arranges for a Ringside Doctor All athletes must be members in good standing with Muaythai Canada All athletes and demonstration participants must sign a Release of Liability and Waiver or Claims Form against Muaythai Canada and its directors, officers, members, staff, coaches, servants, employees, agents, and representatives. Completed sanction forms and insurance certificate must be submitted prior to granting of sanctioning Once sanctioning has been approved, the Muaythai Canada logo should appear on all event advertising Applicable Documentation Checklist Proof EMS attendance Proof of Security personnel/local police Proof of Ringside Doctor Insurance certificate Payment of fees All promoters must submit event results within one week of completion of the event. All events should be professionally recorded with DVD copies available in the event of a protest.Information Acknowledgement*I have read and agree to the Muaythai Canada Event Host responsibilities and guidelines. Yes Event Host Name (Club/Promoter)*Event Host Contact Name* First Last Event Host Contact Email*A receipt and email confirmation will be sent to this address. Event Host Contact Phone*Event Host Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Insurance InformationMuaythai Canada requires a minimum of $2 million in General Liability insurance with Muaythai Canada, the venue and the local officials association named as additional insured, please attach a copy of the insurance certificateInsurance Company Name*Insurance Policy #*Insurance CertificateInsurance Contact Name* First Last Insurance Contact Email* Insurance Contact Phone* Event Name*Event WebsiteIf the website is not known at this time please be sure to inform Muaythai Canada if it is created. Event Facebook PageIf the Facebook page is not known at this time please be sure to inform Muaythai Canada if it is created. Event Ticket URLIf the ticket URL is not known at this time please be sure to inform Muaythai Canada if it is created. Event Start Date* Weigh-ins & Medicals* HH : MM AM PM Event Doors Open* HH : MM AM PM Time of First Bell* HH : MM AM PM Estimated End Time* HH : MM AM PM Is this a multi-day event?*YesNoEvent End Date* Advanced Ticket Price*If the ticket price is not known at this time, please provide your best estimate and update Muaythai Canada when more information becomes available.Please enter a value greater than or equal to 0.Door Ticket Price*If the ticket price is not known at this time, please provide your best estimate and update Muaythai Canada when more information becomes available.Please enter a value greater than or equal to 0.Will your event have VIP seating options available?*YesNoVIP Ticket Price*If the VIP ticket price is not known at this time, please provide your best estimate and update Muaythai Canada when more information becomes available.Would you like Muaythai Canada's event announcement to include a request for athletes?*Any inquiries from athletes/coaches regarding match ups will be forwarded to the Event Host contact email.YesNoVenue InformationVenue Name*Venue Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Venue Contact Name* First Last Venue Contact Email Venue Contact Phone*Bout InformationProposed Bout ListPlease include the event line up. All fighters with less than 5 bouts MUST wear head gear.AgeWeight (kg)Class (Open, A, B, C)Athlete 1Gym 1Athlete 2Gym 2 Optional Event Performance Information CollectionMuaythai Canada is committed to the development and support of Muaythai in our country. In order to bring the sport of Muaythai the legal recognition it so desperately deserves, Muaythai Canadais engaged in advocacy efforts with various government agencies and officials. Much of the information we would need to convey in our tireless efforts would come from you, the hosts and promoters. Muaythai Canada is committed to protecting your privacy. Muaythai Canada will never disclose your name or any other personal information to outside parties. Muaythai Canada will never disclose the information you provide for a particular event. Any numbers and/or information that you provide will only be released in aggregate with information from other events in a specified time period. No event will ever be singled out. The information will only be used to demonstrate the economic benefits of Muaythai through reports that show, among other things, the total revenue generated in a certain number of events by geographic location, the average revenue of events, the market reach, etc. In order to improve and fund Muaythai Canada's advocacy efforts, Muaythai Canada also conducts market research and attempts to attract organizational and athletic sponsorships. Your cooperation is vital to Muaythai Canada's cause, and we appreciate your support! Sincerely, Muaythai CanadaRelease and Confidentiality AgreementI agree to provide Muaythai Canada at the end of the event with the following information: Attendance numbers, gross revenue, guest demographics by age, number of staff utilized (paid vs unpaid), etc. By signing this confidentiality agreement you agree and consent to Muaythai Canada's transmission, collection, maintenance, processing, and use of this information for the purposes of marketing and supporting the advocacy efforts to promote the status of Muaythai in Canada, as described above.ConsentDo you consent to Muaythai Canada's Release and Confidentiality Agreement? (Optional) Yes Event Format*Single Contest ($100)TournamentTournament format event prices can be negotiated with Muaythai Canada.Will any of the bouts be for a Muaythai Canada title?*YesNoNumber of Title Bouts*At the present time the Event Host is responsible for providing the title belts awarded to athletes. In the near future, Muaythai Canada belts will have a standardized design and be provided to the Event Hosts.1 bout2 boutsTotal CAD$ 0.00 CAD Payment Method*Credit CardBilling OverrideIf you have already submitted a payment for your event please enter the billing override code here.Credit Card*Payment by MasterCard or Visa MasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Security Code Cardholder Name Cardholder Email* Cardholder Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Please address and mail your cheque/money order to Muay Thai Ontario 153-155 Limestone Crescent Toronto, ON M3J 2R1Please send your email money transfer to firstname.lastname@example.orgRelease and Waiver1. I am an authorized representative of the abovementioned corporation/company. 2. By signing this agreement, I warrant that I have read and understood the Rules and Regulations for Muaythai Canada approved competitions. If my application for sanctioning is declined I will be refunded the full amount by the payment method selected. 3. I also understand and agree that failure to fulfill any Muaythai Canada policy or procedure will result in the event sanctioning being withdrawn. 4. I will ensure that all bouts and athletes meet all Muaythai Canada requirements. 5. I understand and agree that if the event is cancelled for any reason that my sanctioning fee is non-refundable.Agreement to Release and Waiver* I have read and agree to the release and waiver and am an authorized representative of the Event Host, over the age of 18 Representative's Signature (Type Full Name)* This iframe contains the logic required to handle Ajax powered Gravity Forms.