Combatant/Boxing License Application

Combatant/Boxing License Application

Download PDF Version Here OR fill out the form below

I am a:
Boxer
MMA Fighter

Next Event Date:

Full Name (First Middle Last):

Date Of Birth (Month/Day/Year):

Drivers License:

Number:
State:

Place Of Birth (City, State, Country):

Current Street Address:

City, State, Zip, Country:

Home Phone:

Cell Phone:

Email:

Height:

Weight:

Hair Color:

Eye Color:

Distinguishing Characteristics (tattoos, scars, etc.:

Record as a Professional:

Wins:
Losses:
Draws:
Stance:

Amateur Expericence: Yes No

Record:

Manager:

Name:
Phone:
Email:

Trainer:

Name:
Phone:
Email:

Gym:

Name:
Phone:

Emergency Contact:

Name:
Phone:

Terms and Conditions:

1. Combatant must apply for Boxer/MMA Federal ID card in the state in which he/she is a resident.

2. Combatant understands that he/she will not be allowed to fight in MN without a State of Minnesota License.

3. Any false or misleading statements on this application may result in the Combatant being placed on the National Suspension list.

4. Combatant understands that cooperation with the issuing Boxing Commission may be required to settle any disputes or violations.

5. Combatant agrees to abide by these terms and conditions and any other rules set forth by the Boxing Commission that issued the license. Combatant agrees to pay $25.00 to the MN Combative Sports Commission for licensure.

6. Licensee agrees to test for HIV, Hepatitis B and Hepatitis C annually. Licensee also agrees to provide Boxing Commission with results and proof of testing.

7. License ID card will not be issued unless an accurate and truthful application is complete with two passport size photos, paid fee, proof of blood work and picture ID.

8. The State of Minnesota reserves the right to amend these terms and conditions.

I solemnly swear (or affirm) that the statements made on this application are true and the photograph attached is a true likeness of me.  By signing this application I agree to be bound by the rules and regulations of the State of MN Combative Sports Commission.  If I make a false or misleading statement in this application the State of MN Combative Sports Commission can at any time thereafter place me on suspension for one year.  I acknowledge that I have read, understand, and agree to the terms and conditions of licensure.

Blood work and any additional medical testing must be mailed, faxed or e-mailed directly from clinic or lab administering tests. Requirements must be received at least 7 days prior to event. Mail two passport size photos, copy of blood work and a $25 check made payable to MN Combative Sports Commission to:

MN Combative Sports Commission
National Sports Center, Schwan Center
1700 105th Avenue NE
Blaine, MN 55449

I hereby grant the MN Combative Sports Commission to share blood work/medical results with other commissions for purposes of licensure:
Grant Don't Grant

If you have any questions contact us.

Please Initial and Date:

Initial:
Date:

The State of Minnesota, in compliance with Statute 13.41 Licensing Data, views all information submitted by any applicant for any license to be public.