Fees: $130 entry fee (includes state licensing fee) per fighter will be collected at time of draw on February 28, 2009.

All fees must be paid by cash only.

Mail entries to Tommy G Productions: 23344 Hwy 50 East - Pueblo, CO - 81006. For more information 719.583.0844

Entry Deadline: February 25, 2009 by 5 pm MST.

Bold yellow fields are required.

Legal Name:
Ring Name:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Home Phone:
Work Phone:
Cell Phone:
E-mail Address:
SocialSecurity #:
Age:
Date of Birth:
Sex:
Height:
Weight:
Weight Class:	Lightweight (185 lbs and below) Heavyweight (185.1 and up)
Occupation:
Employer:
Physician's Name:
Physician's Address:
Sponsors (if any):
Have you had a physical examination within the past 12 months?:
Do you have any physical or medical problems?:
Have you ever fought in a professional fight?:	Yes No
Do you have a Boxers' Federal ID Card?:	Yes No
Have you ever fought in a professional fight, Golden Gloves, kickboxing or other amateur boxing event?:	Yes No
If Yes, please provide category, date and event location:
Comments:

By submitting this form you agree that you have read, understand and will abide by the stated Rules & Regulations.