2017 Lowell/Central NE Golden Gloves Registration Form

The tournament is open to male and female boxers, 17 to 40 years old, novice and open class.
Foreign athletes are eligible to compete in the novice class only.

All boxers must be registered with USA boxing. Boxer must present passbook (with current 2017 membership card and signed medical form) before weighing in.

TOURNAMENT REGISTRATION DEADLINE IS JANUARY 7th, 2017

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*** Please use this form to register for the Lowell / Central New England Golden Gloves ONLY ***
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For information on the WESTERN NEW ENGLAND GOLDEN GLOVES:
http://www.wneboxing.com/wne-golden-gloves.html or contact Dean Fay at 413-348-9092

For information on the SOUTHERN NEW ENGLAND GOLDEN GLOVES:
Please contact Paul Morrissette at 508-636-6173, or pmorrissette28@msn.com

For information the NORTHERN NEW ENGLAND / VERMONT GOLDEN GLOVES:
Please contact Ernie Farrar at 802-527-2936

For all tournament dates and locations please see USA Boxing New England Events Calendar:
http://usaboxingnewengland.org/events/

Boxer's First Name *
Your answer
Boxer's Last Name *
Your answer
Boxer's Date of Birth *
ELIGIBILITY: boxers between 17 and 40 years old are eligible to enter (no younger than 17 at start of tournament, and no older than 40 years old at end of tournament)
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Boxer's Phone Number *
Your answer
USA Boxing Member ID Number *
Your answer
Division *
Novice: boxers with 10 bouts or fewer, Open: boxers with more than 10 bouts
Weight Class *
Record (wins-losses) *
Example: 4 wins, 2 losses (or, 4-2)
Your answer
Gym *
Your answer
Coach's Name *
Your answer
Coach's Phone Number *
Your answer
INJURY / ACCIDENT WAIVER: By submitting this form I certify that the boxer being entered is over 18 years of age, or has permission from their parent or legal guardian to participate in the New England Golden Gloves Boxing Tournament. Submission of this form waives and releases any and all rights and claims for damages for any and all injuries suffered during or in preparation for the New England Golden Gloves Boxing Tournament. *
Required
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