Fillable Application For An Iowa Wrestling Event License (Office of the Chief Information Officer)

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Application For An Iowa Wrestling Event License (Office of the Chief Information Officer)

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Country of origin: US
File type: PDF

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BROWSE OFFICE OF THE CHIEF INFORMATION OFFICER (IA) FORMS

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Iowa Division of Labor
Athletic Commission
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-725-5620
Fax: 515-281-7995
athletics@iwd.iowa.gov
athletics.iowa.gov
Event License Number:
Event Attendees:
FOR OFFICE USE ONLY
Application for an Iowa Wrestling Event License
This completed application and $100.00 non-refundable event license fee must be submitted to the Iowa
Division of Labor at the above address, no later than seven days prior to the event.
Promoter business name
Promoter name
Mailing address
City
Zip
Phone number
Mobile phone number
Email address
Only One Event per Application
Event Date Event Location Name
Event Location Address Event City
I have read Iowa Code Chapter 90A regulating the conduct of professional athletics and the Administrative
Rules of the Athletic Commissioner and will conform to their requirements in all respects.
I understand this license authorizes me to conduct this athletic event only on the date and place specified
above.
I understand I must file an Events Receipt Report regarding attendance and receipts with the Athletic
Commission within 20 days after each event. The Events Receipt Report shall be accompanied by a check
payable to the Iowa Athletic Commission and a check payable to the Iowa Department of Revenue, sent to
the address above.
Promoter’s Signature Date
900-001
09.06.2019
Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities.
For deaf and hard of hearing, use Relay 711.
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Application For An Iowa Wrestling Event License (Office of the Chief Information Officer)

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Completed 13 August 2020

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