* 1. Athlete Information

2. Hotel Name

3. Name Hotel Registration Is Made Under

4. Shirt Size (Registration must be received by June 26th)

5. Your Weight - Expected on July 17th

* 6. Date of Birth (Month/Day/Year)

* 7. Number of Bouts Over Lifetime

* 8. 2013 USA Boxing Registration Number

9. Local Boxing Club Name/Affiliation

10. Coach's Name

11. Coach's Phone Number (Accessible At The Event)

12. Payment Type

T