Boxer Licence Form | PBA BOXING

PBA Annual Licence Type:

White Collar Boxer Licence35

Amateur Boxer Licence50

Semi Professional Boxer Licence100

Professional Boxer Licence150

ICB Memberships start January 1st, ends 31st December

Full Name:

Date of Birth

Month

Day

Year

Address:

Phone:

Email

Orthodox or Southpaw:

Orthodox

Southpaw

Current Weight:

Boxing Weight:

Boxing Record:

Include all boxing experience: White-collar, Amateur, Semi-Pro & Pro

Date of previous boxing bout:

Result of previous boxing bout:

Held a boxing licence previously?

Yes

No

If Yes, name of sanctioning body:

Are you currently signed to a boxer/manager contract?

Yes

No

If Yes, name of manager and date of expiry:

I agree to adhere to the PBA's rules and regulations relating to the boxer licence I seek to obtain.

Once the licensing application is submitted and payment is received, the PBA will provide the required medical forms for completion via email.

PBA BOXER LICENCE APPLICATION