Boxer’s Federal Identification Card Application

# ____________________________EXPIRATION DATE _________________________

FULL NAME _________________      ____________   ___________  __________________ ______
                    First                                  Middle                   Last

DATE OF BIRTH______ /_____ /________ SOCIAL SECURITY_____________       
Month        Day           Year

PLACE OF BIRTH Country____________________________  City______________State_________

ADDRESS Street________________________________  City______________ Country ______

State __________ Zip Code __________ Phone number _(     )___________________ Email ______________________________

HEIGHT: _________ WEIGHT: _______ _    STANCE (check only 1): RIGHT_____ LEFT_ ____

HAIR COLOR: ________ EYE COLOR: _______

( tattoos, scars, etc) ______________          _____   _________

MANAGER Name: ________________________________  E-mail or phone _______________________________________________

PROMOTER Name:_______________________________  E-mail or phone ________________________________________________

TRAINER Name:_______________________________ E-mail or phone ________________________________________________

AMATEUR EXPERIENCE: Yes ___   No ____  Record _______________

1.       Boxers must apply for Boxer Federal ID card in the state in which he/she is a resident.
2.       Boxer Federal ID card will not be issued unless an accurate and truthful completed application for ABC Boxer Federal ID Card, two passport photos and two forms of ID.
3.       Boxer understands that he/she will not be allowed to fight without a Boxer Federal ID Card.
4.       Any false or misleading statements on this application may result in the Boxer being placed on the National Suspension list.
5.       The ABC reserves the right to amend these terms and conditions.
7.       Boxer understands that the ABC with the cooperation with the Boxing Commission that issued the Federal ID Card will settle any disputes or violations of terms and conditions for these cards.
8.       Boxer agrees to abide by these terms and conditions and any other rules set forth by the ABC and the Boxing Commission that issued the identification card.

I solemnly swear (or affirm) that the statements made on this application are true and the photograph attached is a true likeness of me.  By signing this application I agree to be bound by the rules and regulations of the ABC.  If I make a false or misleading statement in this application the ABC at any time thereafter may place me on suspension for one year.  I acknowledge that I have read, understand, and agree to the terms and conditions of the ABC Boxer Federal Identification Card.

Applicant’s Signature ________________________________

Date ________________________

Commission Representative __________________________________

Date ________________________