2019 USIBA NATIONAL TOURNAMENT EVENT REGISTRATION FORM
You MUST complete and submit this form to register for the 2019 National Tournament. ALSO, please make sure you pay your entry fee by clicking on the PayPal link at the bottom of the page. Registration is complete when you complete the submit the Event Registration Form, pay the entry fee using the PayPal link, and have a current USA Boxing membership.
LAST NAME *
Your answer
FIRST NAME *
Your answer
USA BOXING MEMBER ID NUMBER *
*YOU MUST HAVE A VALID/CURRENT USA BOXING MEMBER ID*
Your answer
EMAIL *
Your answer
COLLEGE OR UNIVERSITY *
Your answer
BOXER PHONE NUMBER *
Your answer
COACH NAME *
Your answer
COACH PHONE NUMBER *
Your answer
GENDER *
WEIGHT DIVISIONS FOR NATIONALS
MALE FEMALE
108 106
114 112
123 119
132 125
141 132
152 141
165 152
178 165
189 178
201 178+
225
225+

WEIGHT DIVISION *
SKILL DIVISION *
CURRENT RECORD
WINS *
Your answer
LOSSES *
Your answer
DATE OF BIRTH *
MM
/
DD
/
YYYY
*PLEASE READ AND ACKNOWLEDGE THE WAIVER BELOW* *
In consideration of your acceptance of this entry to participate in the 2018 USIBA National Tournament and activities connected to same, I hereby, for myself, my heirs, executors, administrators and assigns and personal representatives waive and release any and all right to any claim for damages I may or might have against USA Boxing, Inc. and USA Boxing, USIBA, sponsors and venue owners of this event or the officers, members, employees, subcommittees, agents, representatives and assigns of these entities, for any injury or damages suffered by me, whether arising from the negligence of the releases or otherwise, all claims, actions, suits, proceedings, costs, expenses, damages and liabilities arising out of, compile with or resulting from, my participation in the 2018 USIBA National Tournament, including, without limitation, any injuries or damages, and or arising from traveling to and/or returning from the 2018 USIBA National Tournament. I agree for myself and my heirs, distributes, guardians, legal representatives, and assigns that in the event that any claims for personal injury, death, or property damage shall be prosecuted against the USA Boxing or USIBA, their members, officers, employees, or agents, I shall indemnify and hold harmless the United States Intercollegiate Boxing Association or United States Amateur Boxing their members, officers, employees, or agents from any and all such claims or causes of action by whoever made and wherever presented. I agree to abide by the rules of U.S.A. Boxing. If I observe any unusual, significant violations or hazards during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. I fully understand that I assume all responsibility for any injury or damage that I may incur in these boxing bouts. I understand and agree that medical or other services rendered to me by or at the insistence of any of the named parties are not an admission of liability to provide or continue to provide any such services and is not a waiver by any of said parties of any right or rights hereunder. I certify that I have no injuries to my hands, neither fractures nor broken bones, within three (3) years preceding the dates of this entry form, and know of no other injuries to the head, concussion, fainting spells, and will notify boxing officials immediately should any of these injuries and conditions be experienced in the future. In addition, I also understand and appreciate that participation in sports carries a risk to me of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept, and assume this risk. I, as a member of the United States Amateur Boxing (USA Boxing), understand and must comply with the guidelines as set forth in USA Boxing’s Code of Conduct. I understand that this Code of Conduct applies to any and all athlete and non-athlete members of USA Boxing while participating in USA Boxing sponsored activities. I also understand any and all athlete and non-athlete members are required to abide by this Code of Conduct and all United States Olympic Committee policies, rules and regulations. I acknowledge and accept the consequences and disciplinary procedures that could be enforced if I violate any of the codes/rules. I have read all tournament literature and accept terms.
Required
*FEMALE BOXERS: PLEASE READ AND ACKNOWLEDGE THE WAIVER BELOW*
I CERTIFY THAT I AM NOT PREGNANT, NOR DO I HAVE ANY PAINFUL PELVIC DISCOMFORT SUCH AS SYMPTOMATIC ENDOMETRIOSIS OR OTHER CAUSES, ABNORMAL VAGINAL BLEEDING OF UNDETERMINED CAUSES (ETIOLOGY), RECENT LOSS OF MENSTRUAL PERIOD (SECONDARY AMENORRHEA), RECENT BREAST BLEEDING, RECENTLY DEVELOPED BREAST MASS, RECENT BREAST DYSFUNCTION PREVIOUSLY NOT PRESENT OR SURGICAL BREAST IMPLANTS, AND HAVE READ SECTION 101.9(4) OF USA BOXING’S OFFICIAL RULES PERTAINING TO MY PRESENT PHYSICAL CONDITION. I FURTHER AGREE THAT I WILL IMMEDIATELY NOTIFY MY COACH, TRAINER OR OTHER LOCAL BOXING OFFICALS IF ANY OF THE ABOVE DESCRIBED CONDITIONS SHOULD DEVELOP/APPLY.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.