MALAYSIA OPEN KOSHIKI CHAMPIONSHIP

2017

ENTRY FORM (FOR MALE)

82 KG & ABOVE

UNDER 82 KG

UNDER 73 KG

UNDER 63.5 KG

NAME OF CONTESTANT

UNDER 58 KG
WEIGHT (KG)

DATE OF BIRTH

HEIGHT (CM)

No.

WEIGHT (KG)

NAME OF ASSOCIATION & COUNTRY:

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Signature & Rubber Stamp of Association
Name:
Position / Title :
Address:

CLOSING DATE: 15/06/2017