Registration – NLA Boxing

REGISTRATION FORM

FOR
The NLA Boxing – King of the Jungle 5 – National Championships – Unfinished Business

Name:

Phone Number:

Email Address:

Birth Date:

Age That You Will Be on October 14, 2023

Gender:
MaleFemale

Street Address:

City:

State:

Zip:

Division:
Novice - (9 bouts or less)Open - (10 bouts or more)

Number of bouts:

USA Boxing Registration Number (If Available)

Name of Your Boxing Club:

Coaches Name:

Coaches Phone Number (If Available):

USA Boxing Weight Class that You will be Competing In:

Division that you are entering in:
Bracketed Tournament DivisionMatched Bouts OnlyDevelopmental Division

If you would like to have your photo appear in our event marketing, please attach one or two recent, "Boxing Pose" photos here:

QUESTIONS?

Call John O’Brien, Tournament Director