Fillable Box.id1 Box.id1 .pdf (Office of the Chief Information Officer)

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Box.id1 Box.id1 .pdf (Office of the Chief Information Officer)

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Association of Boxing Commissions (ABC)
Boxer’s Federal Identification Card Application
State of Iowa Boxing Commission
I solemnly swear (or affirm) that the statements made on this application are true and the photograph is a true representation of
me. By signing this application, I agree to be bound by the rules and regulations of ABC. If I make a false or misleading
statement in this application, 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 Identification card.
Federal ID Number
Expiration Date
First Name
Middle
Last
Date of Birth
Social Security Number
Current Mailing Address
City
State
Zip
Phone Number
Email Address
Height
Weight
Stance
Left Right
Amateur Experience
Yes No
Record
Hair Color
Eye Color
Distinguishing Characteristics (tattoos, scars, etc.)
Manager Name
Phone Number
Email Address
Promoter Name
Phone Number
Email Address
Trainer Name
Phone Number
Email Address
TERMS AND CONDITIONS
1. Boxer 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 an ABC Boxer Federal ID card, one
passport picture 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. ABC reserves the right to amend these terms and conditions.
6. Boxer understands that ABC with the cooperation of the State of Iowa Boxing Commission will settle any disputes or violations of these
terms and conditions.
7. Boxer agrees to abide by these terms and conditions and any other rules set forth by ABC and the State of Iowa Boxing Commission.
06.18.2020
300-003
Applicant’s Signature Date State of Iowa Boxing Commission Representative Date
Chapter 90A of the Iowa Code requires each professional boxer residing in Iowa to register with the Commissioner of Athletics
every two years.
Send the following to the Iowa Division of Labor – Athletics, 150 Des Moines Street, Des Moines, IA 50319-0209
1. Completed legible application
2. 2 forms of Identification – 1 copy of official government issued photo ID containing the boxer’s photograph or similar
foreign ID number and 1 copy of a different acceptable form of ID (i.e. social security card, military card or PIV card)
3. Current clear facial picture (picture ONLY may be emailed to the address below)
4. Check or money order for $25.00 payable to Division of Labor – Athletics
Application must be received by the Athletic Commissioner 15 days prior to a boxing match that the boxer will be participating in.
If you have questions, call 515-281-6175 or email boxing@iwd.iowa.gov.
Date Received:
Check Number:
ID Issuance Date:
FOR OFFICE USE ONLY
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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Box.id1 Box.id1 .pdf (Office of the Chief Information Officer)

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Completed 20 July 2020

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