* 1. Athlete Information

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

* 3. Number of Bouts

* 4. 2017 USA Boxing Registration Number

* 5. Local Boxing Club Name/Affiliation

* 6. Coach's Name

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

* 8. Payment Type 
Checks should be made to: Las Vegas Elite Boxing and mailed to:
Gil Martinez
3874 Silvestri Ln.
Las Vegas, NV 89120

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