Individual Boxer Registration Form
Today's Date
*
/
Month
/
Day
Year
Date
Female or Male?
*
Female
Male
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
Name of LBC
*
Your USA Boxing Registration Number
*
Age that you will be on Wednesday, July 12, 2017?
*
Competing in the following age group:
*
14 to 15
16 to 17
18 to 40
Male: 14 to 15 years old weight class
85
90
95
101
106
110
114
119
125
132
138
145
154
165
176
176+
Male: 16 to 17 years old weight class
95
101
106
110
114
119
125
132
138
145
154
165
176
201
201+
Male: 18 to 40 years old weight class
108
114
123
132
141
152
165
178
201
201+
Female: 14 to 15 years old weight class
85
90
95
101
106
110
114
119
125
132
138
145
154
165
176
176+
Female: 16 to 17 years old weight class
95
101
106
110
114
119
125
132
138
145
154
165
176
201
201+
Female: 18 to 40 years old weight class
106
112
119
125
132
141
152
165
178
178+
Competing at the following experience level. Select what your experience will be on July 12, 2017.
*
Novice ( 9 bouts or less )
Open (10 bouts or more)
Total number of amateur bouts
*
Coach Name
*
First Name
Last Name
Coach E-mail
*
Coach Phone Number
*
-
Area Code
Phone Number
Name of your Boxing Club
*
City and State of your Boxing Club
*
Name of Parent or Legal Guardian (If you are under 18 years old.)
Parent or Legal Guardian Address (If you are under 18 years old.)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent or Legal Guardian E-mail (If you are under 18 years old.)
Parent or Legal Guardian Phone Number (If you are under 18 years old.)
-
Area Code
Phone Number
If you would like to attach one photo of yourself, please do so, using the Attachment option provided. By doing so, you agree to allow the National Latino Amateur Boxing Association to use your photo on advertising, Facebook, email marketing, and similar means of advertising and promoting the King of the Jungle Nationals. You will be identified by your name, Boxing Club and City if your image is used by the NLABA.
Browse Photos on Your Computer and Attach Here!
Submit
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