You may submit your eye exam for your upcoming fight below. Must be jpg, png or pdf and 8mb file size or smaller.

Note: VA Law requires that all contestants, pro or amateur, have blood work and a physical or doctor's medical clearance within 180 days of your bout. See below for details and links.

(* indicates required fields)

Full Name*

Email*

Image/File size limit 8mb

Please Attach a copy of your current eye exam* (must be within one year of your fight)

Please Attach a second page of eye exam if necessary

Please Attach a third page of eye exam if necessary

Please leave this field empty.

You must also certify that you have, or will have before your fight, your own medical insurance.

Waiver: By your submission, you agree to be added to our email list and grant Wylde Style Productions (hereinafter referred to as "WSP") and/or its parent company, affiliates or subsidiaries a royalty-free, world-wide, perpetual, non-exclusive license to display, distribute, reproduce, and create derivative works of the submission, in whole or in part, in any media now existing or subsequently developed, for any purpose, including, but not limited to advertising and promotion of WSP and/or its parent company, affiliates or subsidiaries, and its website, exhibition, and commercial products. Any photograph reproduced may include a photographer credit at photographer’s request and by permission of WSP and/or its parent company, affiliates or subsidiaries at its sole discretion. WSP and/or its parent company, affiliates or subsidiaries will not be required to pay any additional consideration or seek any additional approval in connection with such uses.