Confidential Charitable Fund Request Application – Association of Boxing Commissions

Application Date *

Name of Requestor or Organization *

Contact Name *

First

Last

Day Phone

Mobile Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Amount Requested *

Please describe your involvement with Combative Sports *

What is the intended use of the Funds? *

Can you attach documents in support of the request? *

SS# or TIN# *

If an Organization, please attach your federally-issued tax-exempt status letter and provide the names of the members of your Board of Directors *

Supporting Document

Name

Note: To qualify, a combative sports fighter must not have been active for the past 12 months and all
applications must be received by June 30.