* 1. Fighters Information

* 2. Coach Information

* 3. Local Boxing Club Name/Affiliation

* 5. Weight Class

* 6. Total number of Amateur Bouts

* 7. Age of fighter

* 8. Fighters Date of Birth

* 9. Sex

* 10.  Mail Entry Fee to P.O. Box 882 O'Fallon, IL 62269

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