1 Introduction2 Event Information3 Athlete Information4 Signature5 Payment The Canadian Youth National Muaythai Team The Canadian Youth National Muaythai Team is comprised of the country's best young competitive athletes, and represents Canada at competition held under jurisdiction of the International Federation of Muaythai Associations (IFMA). The Youth National Team, while high performance in nature, is focused on providing young athletes challenging competitive opportunities that allow them to develop along the pathway to Elite World Championship (and eventually, Olympic) Gold. Qualifying for the Youth National Team Qualification for the Youth National Team is made up of two parts 1) qualification through competition at the National Championship and 2) qualification through application/selection. Qualification through the National Championship Each year, Muaythai Canada hosts the Canadian National Muaythai Championship, the largest multi-day Canadian tournament that also serves as the National Team and Youth National Team qualifiers. Athletes who medal or are uncontested in the qualifying divisions are added to the National Team pool for the entire year, and can then be submitted to attend international competition with Muaythai Canada. Qualification through Application & Selection Youth athletes grow up and grow bigger very quickly. Muaythai Canada recognizes that when divisions are made up of 2 year age differences and 2 year weight differences, the division an athlete qualified for at Nationals may be very different from the athlete's age & weight division in a few months time. To address this, Muaythai Canada takes additional young athletes on a per event basis, which is the purpose of this application. Application Deadlines August 16th, 2019: First application window deadline August 19th, 2019: First round team selection announcement August 23rd, 2019: 2nd round (late) application deadline August 26th, 2019: 2nd round team selection announcement Application Requirements Overview of Information to Submit Athlete name, age, contact information, & club affiliation; Athlete competitive history across all combat sports; Athlete's desired competitive division; Agreement to the application waiver; and Payment of $40 application fee. General Eligibility Athlete must be a member of a registered Muaythai Canada Club to apply Athlete should meet the recommended experience for their division (4+ full contact bouts for ages 10-13, 10+ full contact bouts for ages 14-17) The Selection Process Applications will be reviewed by a Selection Committee appointed by the Muaythai Canada board of directors. This committee will include one (1) representative from Western Canada, one (1) reprentative from Central Canada, one (1) representative from Eastern Canada, one (1) represenative from the Muaythai Canada Board of Directors, and one (1) representative from the Muaythai Canada Youth Commission. Should the Selection Committee require additional information in order to support an athlete's application (i.e. competition video), they may request this at any time. The Selection Committee shall not cast a vote for selection of divisions in which an athlete affiliated to them has applied. 2019 IFMA Youth World Championship, Antalya, Turkey At a Glance Event Dates: September 24th – October 6th, 2019 Competition Venue: Kervansaray Lara Hotel, Antalya, Turkey Tournament Accommodation: Kervansaray Lara Hotel, Antalya, Turkey Estimated Cost: $1,517 to $2,060 CAD + flights Participation Requirements (to be submitted after selection) For all Participants: 2019 Muaythai Canada Membership; 2019 Provincial Sport Organization Membership where available; Completed National Team Contract & $300 deposit; and Valid passport, and passport scans (no cell phone pictures). For Athletes: MTC Medical declaration (dated March 28th, 2019 or later); Anti-Doping Consent Form; [Age 16+] HIV, Hep B, Hep C blood tests (dated March 28th, 2019 or later); [Female Athletes] Pregnancy declaration (Females); and [Returning Athletes] IFMA membership book. For Coaches & Technical Officials: Up to date Background Screening. Important Deadlines for Selected Athletes September 1st, 2019: Last day to complete 2019 National Team Contract and $300 deposit payment September 15th, 2019: Last day for online registrations, medical form upload September 15th, 2019: Deadline for accommodation payment to Muaythai Canada Tournament Schedule Day Date Activity 1 September 24th, 2019 • Team arrival, check in at team hotel 2 September 25th, 2019 • Team training 3 September 26th, 2019 • Team training 4 September 27th, 2019 • Team training 5 September 28th, 2019 • Morning: Transit and check in at Official Hotel • Afternoon: 1st Official Weigh-in 6 September 29th, 2019 • Morning: 2nd Official Weigh-in • Afternoon: Opening Ceremony 7 September 30th, 2019 • Preliminary Bouts 8 October 1st, 2019 • Preliminary Bouts 9 October 2nd, 2019 • Quarter-final Bouts 10 October 3rd, 2019 • Semi-final Bouts, Muay Talay Tournament 11 October 4th, 2019 • Rest Day / Youth Conference & Social Programme 12 October 5th, 2019 • Finals Bouts & Medal Ceremonies 13 October 6th, 2019 • Departures Expected Tournament Costs Amounts are estimated and converted to CAD. Muaythai Canada 2019 Membership Fee $50 CAD IFMA 2019 Membership Fee + Book $34 CAD (25 USD) Travel Insurance (13 Days @ $5 CAD per day) $65 CAD MTC National Team Uniform $110 CAD IFMA Competition Uniform $80 CAD (60 USD) Accommodations at Team Training Hotel $200 CAD Tournament Accommodations & meals (8 nights @ $92 to 143 USD per day depending on room size) $978 to 1,520 CAD (736 to 1,144 USD) Total $1,517 to $2,060 Team Training The National Team will be arriving on September 24th 2019 for team training, as well as adjust to the local climate and timezone. The location of the training facilities is currently TBD. Mandatory Championship Accommodations All athletes, coaches, officials, team team managers, & team trainers must stay at the designated hotel accommodations, booked through Muaythai Canada. Parents, Guardians, & Entourage Parents and guardians are welcome to stay with the Youth National Team alongside the athletes, or may opt to book separate accommodations for themselves (usually at a lower cost). All parents and guardians must agree to abide by the Muaythai Canada code of conduct and international competition policies regardless of whether they are booking in to the official accommodation through Muaythai Canada or booking their own accommodation. Parents and guardians set an example for our young athletes, and are expected to represent our country well at international events. Should a parent or guardian be in violation of Muaythai Canada policies they may be removed from the National Team's activities at the Championship. Additional entourage (friends, general family, etc) are responsible for their own travel and accommodation, and are booked separately from the team. Arranging Flights, Travel Muaythai Canada is currently exploring different travel options to Antalya. Options may include landing in Istanbul and taking ground transportation, or flying directly to Antalya airport. Ultimately participants are responsible for their own flight arrangements and are welcome to arrive in advance of the mandatory dates as well as stay after the championship's conclusion. If a large group of participants (8+) are interested in sharing an itinerary, Muaythai Canada will explore group discounted travel options. Travel Visas Canadian citizens require a visa to enter Turkey, which can be obtained online from www.evisa.gov.tr/en. Participants who are not Canadian Citizens will need to determine whether they are required to obtain a visa to enter Turkey. Requirements can be checked at www.mfa.gov.tr/visa-information-for-foreigners.en.mfa. Participant's Appearance During competition, athletes must wear the official uniform purchased from IFMA at the event. Toenails must be trimmed, and beards must be clean shaven. When not competing or officiating, all participants must wear their national team uniform whenever present in the competition area (coaching, spectating, on the podium, etc). Athlete Equipment Gloves, head guards, shin guards, elbow guards, body guards, and hand wraps are provided by the organizing committee. Each athlete must provide their own mouth guard, groin guard, and mongkol. Athlete Name* First Last Athlete Email* Enter Email Confirm Email Athlete Gender*MaleFemaleAthlete Birth Date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Athlete Nationality*(Please Select)Canadian CitizenCanadian Dual CitizenPermanent ResidentOtherHas the athlete, in the past 3 years, competed at IFMA under another country's National Federation?*Athletes who have competed under another National Federation in the past 3 years must go through an additional process to compete under Muaythai CanadaYesNoGuardian Contact InformationGuardian Name* First Last Guardian Email* Enter Email Confirm Email Guardian Phone*Relationship to Athlete*Club InformationIn order to apply for the Canadian National Team, athletes must be members of a Muaythai Canada registered club.Club Affiliation*(Please Select)5E Athletics6IX MMA8 Limb Muay Thai905 BJJAcademie FrontenacAction MMAAjax Mix Martial Arts AcademyAll Star Martial ArtsAngry Monkey MMAAPEX Martial ArtsArashi Do Martial Arts Sherwood ParkArt Of 8 Muay Thai & KickboxingArt of Muay Thai & Fitness GymBaldwins Muay Thai & FitnessBarrhaven Martial Arts CentreBlack Lotus AcademyBrampton Muay ThaiBruce County Combat & FitnessBudo CanadaBurlington Training CentreCaged Dragon MMAChampion's Creed Martial ArtsClinch Muay ThaiDarkside Muay ThaiDave’s Nak Muay GymDiablo Muay Thai GymDiamond Muay ThaiDiaz Combat SportsDohjo Muay Thai & FitnessDrouin's Martial ArtsElevation Martial Arts & Training CentreElite Martial Arts AcademyElite Martial Arts TorontoEmpire MMAEtobicoke Martial ArtsEvo GymEvolution BJJ and Muay Thai PetawawaEvolve MMAExperience MMA & FitnessFamily KickboxingFarang Martial Arts Ltd.Fearless MMAFifth Round Muay ThaiFit Plus Martial ArtsFlorin's Ultimate Martial Arts AcademyGlory Training CentreGolden Lion 8 Limbs AcademyGolden TigerH2O MMAHamilton School of Martial ArtsHarrow PerformanceHayabusa AcademyHighland Muay Thai & FitnessHouse Of Champions Martial ArtsIron CityK1 Kickboxing AcademyKalsamrit Muay Thaikawartha combatKemptville Training CentreKombat Arts Training AcademyKonga MMAKrudar Muay ThaiLanna MMALarge Martial ArtsLegacy Fight ClubLegends MMALion Combat AcademyLondon Muay ThaiLotus Fitness & Thai BoxingLoyalist Martial Arts AcademyM-1 Thai Boxing System Inc.MAFA 1991Marine KickboxingMAS ThaiboxingMelbrook Martial Arts AcademyMike Miles Muay Thai & Kickboxing LtdMilton MuayThai Boxing GymMomentum Martial ArtsMontrait Muay ThaiMovement MMAMuay Thai WhitbyMuaythai Ontario Certified OfficialsN1 Thai Boxing AcademyNeak Ta Martial ArtsNew Era Combat SportsNordik Fight ClubNorth training academyNovagymOld School Muay ThaiOttawa Academy of Martial ArtsOttawa Fight & FitnessPlatinum Training FacilityPound 4 Pound Martial ArtsPRIMAL MMA ACADEMYProgressive Fighting AcademyREDEMPTION MUAY THAIRevMMARichmond Hill Muay ThaiRocky Mountain Martial Arts Family CentreSiam No1 Muay Thai AcademySiam no1 QuébecSouthside Muay Thai AcademySparmaxStride Muay ThaiSudbury Kickboxing AcademySudbury MMATeam Bushido MMATeam Shredder / MetaForceThe One Muay Thai and FitnessThe Submission AcademyTitan M.A.CTitans AcademyTKO Fighting Arts : Kitchener Muay ThaiToronto Kickboxing & Muay Thai AcademyToronto No GiToronto Top TeamTotal Martial Arts CenterTravelling Ronin Martial ArtsTristarTriumph Muay ThaiTroop MMATwin Dragon EastUltimate Martial ArtsUndisputed Martial ArtsUnited Brazilian Jiu-Jitsu & Muay ThaiUnited FighterVision Quest MMA & FitnessVRTU Muay ThaiWarrior Muay ThaiWestside Muay ThaiWorld Championship Martial ArtsWTM Muay ThaiYork MuaythaiZen Mixed Martial ArtsCoach Name* First Last Coach Email* Enter Email Confirm Email Coach Phone*Competitive Experience InformationSubmitting false competitive information will disqualify your applicationPlease select all the striking based amateur combative sports experience you have* Amateur Muaythai Amateur Kickboxing Amateur MMA Amateur Sanchou/Sanda Amateur Boxing Amateur Other Amateur Muaythai ExperienceFull Contact Wins*Full Contact Losses*Full Contact Draws*Full Contact Demos/Smokes/Exhibitions*Light Contact Contests*Overall number of light contact bouts participated inAmateur Kickboxing ExperienceFull Contact Wins*Full Contact Losses*Full Contact Draws*Full Contact Demos/Smokes/Exhibitions*Light Contact Contests*Overall number of light contact bouts participated inAmateur MMA ExperienceFull Contact Wins*Full Contact Losses*Full Contact Draws*Full Contact Demos/Smokes/Exhibitions*Light Contact Contests*Overall number of light contact bouts participated inAmateur Sanshou/Sanda ExperienceFull Contact Wins*Full Contact Losses*Full Contact Draws*Full Contact Demos/Smokes/Exhibitions*Light Contact Contests*Overall number of light contact bouts participated inAmateur Boxing ExperienceFull Contact Wins*Full Contact Losses*Full Contact Draws*Full Contact Demos/Smokes/Exhibitions*Light Contact Contests*Overall number of light contact bouts participated inAmateur Other ExperiencePlease indicate what sport(s) your other experience is in*Full Contact Wins*Full Contact Losses*Full Contact Draws*Full Contact Demos/Smokes/Exhibitions*Light Contact Contests*Overall number of light contact bouts participated inTotal Experience - Overall RecordPlease verify that the information below reflects your accurate, overall record. These numbers are calculated from the individual experience you entered above.Total Full Contact Wins*Total Full Contact Losses*Total Full Contact Draws*Total Full Contact Demos/Smokes/Exhibitions*Total Light Contact Contests*Overall number of light contact bouts participated inList of Full Contact Competitive HistoryContest List*Please list your competitive history to match the record below. To add additional rows, click the (+) to the right of the boxes.Date (DD/MM/YY)Sport (MT/KB/MMA, etc)LocationSanction (MTC/MTO/TBA, etc)Weight (kg)OpponentResult (W/L/D/Exh) Youth National Team InformationPlease select the division you wish to apply for. Youth athletes ages 10-13 are recommended to have had 4+ contests experience. Youth athletes ages 14-17 are recommended to have had 10+ competitions experience with at least some international experience and experience competing under full Muaythai rules.Competitive Division: Female*Age as at September 28th, 2019.(Please Select)Junior 16-17Junior 14-15Junior 12-13Junior 10-11Competitive Division: Male*Age as at September 28th, 2019.(Please Select)Junior 16-17Junior 14-15Junior 12-13Junior 10-11Weight Class: Elite Male*The maximum weight of each class is listed(Please Select)48 kg51 kg54 kg57 kg60 kg63.5 kg67 kg71 kg75 kg81 kg86 kg91 kgOver 91 kgWeight Class: Elite Female*The maximum weight of each class is listed(Please Select)45 kg48 kg51 kg54 kg57 kg60 kg63.5 kg67 kg71 kg75 kgOver 75 kgWeight Class: Competitive Male*The maximum weight of each class is listed(Please Select)45 kg48 kg51 kg54 kg57 kg60 kg63.5 kg67 kg71 kg75 kg81 kg86 kg91 kgOver 91 kgWeight Class: Male Youth 16-17*The maximum weight of each class is listed(Please Select)45 kg48 kg51 kg54 kg57 kg60 kg63.5 kg67 kg71 kg75 kg81 kg86 kg91 kgOver 91 kgWeight Class: Female Youth 16-17*The maximum weight of each class is listed(Please Select)42 kg45 kg48 kg51 kg54 kg57 kg60 kg63.5 kg67 kg71 kg75 kgOver 75 kgWeight Class: Male Youth 14-15*The maximum weight of each class is listed(Please Select)38 kg40 kg42 kg45 kg48 kg51 kg54 kg57 kg60 kg63.5 kg67 kg71 kg75 kg81 kgOver 81 kgWeight Class: Female Youth 14-15*The maximum weight of each class is listed(Please Select)36 kg38 kg40 kg42 kg45 kg48 kg51 kg54 kg57 kg60 kg63.5 kg67 kg71 kgOver 71 kgWeight Class: Male Youth 12-13*The maximum weight of each class is listed(Please Select)32 kg34 kg36 kg38 kg40 kg42 kg45 kg48 kg51 kg54 kg57 kg60 kg63.5 kg67 kg71 kgOver 71 kgWeight Class: Female Youth 12-13*The maximum weight of each class is listed(Please Select)32 kg34 kg36 kg38 kg40 kg42 kg45 kg48 kg51 kg54 kg57 kg60 kg63.5 kgOver 63.5 kgWeight Class: Male Youth 10-11*The maximum weight of each class is listed(Please Select)30 kg32 kg34 kg36 kg38 kg40 kg42 kg45 kg48 kg51 kg54 kg57 kg60 kg63.5 kg67 kgOver 67 kgWeight Class: Female Youth 10-11*The maximum weight of each class is listed(Please Select)30 kg32 kg34 kg36 kg38 kg40 kg42 kg45 kg48 kg51 kg54 kg57 kg60 kgOver 60 kg Application Terms & ConditionsI, the undersigned, warrant that the information in this application is true. I understand that providing false information on this form may result in the suspension or the cancellation of my application and membership without compensation.Agreement to Application Terms and Conditions*I have read and agree to the terms and conditions and am a legal guardian of the applicant athleteAthlete Name*Guardian Name*Guardian Signature* Is the athlete a 2019 Muaythai Canada competitive member?*Membership is obtained through your Provincial Sport Organization, or directly with Muaythai Canada.YesNoMembership with Muaythai Canada is a requirement to participate on the Youth National Team. If the athlete is selected for participation, the athlete's placement on the team will not be considered secure until the athlete's membership is received.Application FeeYouth National Team Application Fee Price: CAD$ 40.00 CAD Total CAD$ 0.00 CAD Coupon Payment InformationCredit Card*Payment by MasterCard or Visa American ExpressDiscoverMasterCardVisaJCBMaestro Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name Cardholder Email* Enter Email Confirm Email Cardholder Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe This iframe contains the logic required to handle Ajax powered Gravity Forms.