2017 NATIONAL TITLE BOXING TOURNAMENT Sponsored by Title Boxing HOT SPRINGS NATIONAL PARK

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2 2017 NATIONAL TITLE BOXING TOURNAMENT Sponsored by Title Boxing HOT SPRINGS NATIONAL PARK Registration Fee: $40 through June 05, Online registration ends on June 05, No entries will be accepted after June 5th, 2017 so get them in before 12:00am. You may change weight on check-in day June 7 th, Times and locations may change Event Dates: June 07 - June 10, 2017 Location: Hot Springs Convention Center 134 Convention Blvd., Hot Springs, AR June 07 Check-in and Official Weigh-in: 8 AM to 4 PM Mandatory COACHES meeting 6:00 pm. Brackets will be up for review. Any changes will need to be made by 8:00 pm no changes allowed after close of business on the June 07 th If there is a need for 2 sessions a day we will let you know during coaches meeting. We are expecting over 600+ boxers this year. June 08 Weigh-in Start Time: 9 AM for boxers who compete that day Tournament Start Time: 5:30 PM. If a morning session is required you will know at weigh in time. June 09 Weigh-in Start Time: 9 AM for boxers who compete that day Tournament Start Time: 5:30 PM. If a morning session is required you will know at weigh in time. June 10 Weigh-in Start Time: 8 AM, for boxers who compete that day Tournament Start Time: 3:30pm, Championship Bouts Event Officials: Willie McCoy, Event Coordinator Chad Wade, Co-Event Coordinator crwadefs@yahoo.com Chief Official Sanction: Tournament held under the USA BOXING Awards: Title Belts will be awarded in all age levels. ALL BELTS ARE THE SAME FOR WINNERS AND UNOPPOSED champions. NO TITLE BELTS WILL BE AWARDED BEFORE June 10 th

3 2017 NATIONAL TITLE BOXING TOURNAMENT Sponsored by Title Boxing HOT SPRINGS NATIONAL PARK ATHLETE ENTRY FORM (page 1 of 4) Event Dates: June 07 - June 10, 2017 Location: Hot Springs Convention Center 134 Convention Blvd., Hot Springs, AR Application must be received by June 05, Online/mail in Registration closes June 05, NO Walk ups on June 7 th 2017 U.S. participants must be a current member of USA Boxing in order to compete. International participants must be a current member of local boxing organization in order to compete. Deliberate falsification of entries may result in disqualification from this tournament and/or suspension from USA Boxing. FIRST NAME / LAST NAME ADDRESS (Street/City/State or Province /Zip or Postal Country Code) NOVICE/OPEN/ WEIGHT CLASS /TOTAL # OF BOUTS MALE FEMALE AGE (as of 6/07/17) DATE OF BIRTH 2017 BOXING REGISTRATION NUMBER LOCAL BOXING CLUB NAME/AFFILIATION (REQUIRED) / MOBILE PHONE # (Accessible during Event) COACH S NAME / COACH S PHONE # (Accessible during Event) Entry Fee Enclosed: $40 through June 05, 2017 online registration, NO entries after June 05, 2017 Make check or money order payable to: Hot Springs Boy s & Girl s Club Boxing Team (HSB&GC Boxing Team) Mail registration form and payment to: National Title Tournament Attn: Chad Wade OR register & pay online 9448 Park Ave. Hot Springs, AR

4 ATHLETE ENTRY FORM: DIVISION AND WEIGHT (page 2 of 4) Please circle your Division and Weight. Age is based on Boxer s age on June 08, All Open Class Boxers must have minimum of five (5) recorded bouts in their passbook. Novice boxers cannot have more than 10 recorded bouts in their Passbook. You may choose to go Open with less than 10 bouts, if you have at least five (5) recorded bouts in your Passbook. All Passbooks will be verified. Any deliberate falsification of entries will result in disqualification from the tournament and/or suspension from USA Boxing. THIS WILL BE MONITORED AND ENFORCED. See Competition Weight in the NTBT Fact Sheet for important weight class details. Athlete Name: MENS OPEN MENS OPEN BOYS OPEN BOYS OPEN BOYS OPEN BOYS OPEN 9 10 BOYS OPEN 8 45 WOMENS OPEN WOMENS OPEN GIRLS OPEN GIRLS OPEN GIRLS OPEN GIRLS OPEN 9 10 GIRLS OPEN 8 MENS NOVICE MENS NOVICE BOYS NOVICE BOYS NOVICE BOYS NOVICE BOYS NOVICE 9 10 BOYS NOVICE 8 45 WOMENS NOVICE WOMENS NOVICE GIRLS NOVICE GIRLS NOVICE GIRLS NOVICE GIRLS NOVICE 9 10 GIRLS NOVICE 8

5 ATHLETE ENTRY FORM: WAIVER/WARNING/DISCLAIMER (page 3 of 4) In consideration of my participation in the activities of the 2017 National Title Boxing Tournament and connected activities, I, the undersigned, on behalf of myself, my heirs, representatives, executors, administrators and assigns, do hereby release, indemnify and hold harmless the National Title Boxing Tournament, Hot Springs Boy s & Girl s Club, Arkansas LBC, Hot Springs Convention Center and United States Amateur Boxing, their members, its officers, agents, and employees from any cause of action, claims or demands of any nature whatsoever, which I, my heirs, representatives, executors, administrators and assigns may now have, or have in the future against all parties on account of personal injury, property damage, death or accident of any kind, including any act or omission of any third party (rescue squad, hospital, etc...), arising out of, or in any way related to, my participation in any and all National Title Boxing Tournament activities, whether that participation is supervised or unsupervised, howsoever the injury or damage is caused. I agree myself and heirs, distribute, guardians, legal representatives, and assign that, in the event that any claims for personal injury, death or property damage shall be prosecuted against the National Title Boxing Tournament, Hot Springs Boy s & Girl s Club, Arkansas LBC, or United States Amateur Boxing their members, officers, employees, or agents, I shall indemnify and hold harmless the National Title Boxing Tournament, Hot Springs Boy s & Girl s Club, Arkansas LBC, Hot Springs Convention Center or United States Amateur Boxing their members, officers, employees, or agents from any and all such claims or causes of action by whoever made and wherever presented. I agree to abide by the rules of the United States Amateur Boxing. If I observe any unusual, significant violations or hazards during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. I fully understand that I assume all responsibility for any injury or damage that I may incur in these boxing bouts. I understand and agree that medical or other services rendered to me by or at the insistence of any of the named parties are not an admission of liability. To provide, or continue to provide, any such services and is not a waiver by any of said parties of any right or rights hereunder. I certify that I have had no injuries to my hands, neither fractures nor broken bones, within three (3) months preceding the dates of this entry form, and know of no other injuries to the head, concussion, fainting spells, and will notify boxing officials immediately should any of these injuries and conditions be experienced in the future. In addition, I also understand participation in sports carries a risk to me of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept, and assume this risk. FEMALE BOXERS ONLY: I further certify that I am not pregnant, or have any painful pelvic discomfort such as symptomatic endometriosis or other causes, abnormal vaginal bleeding of undetermined causes (Etiology), recent loss of menstrual period (second amenorrhea), recently developed breast mass, recent breast dysfunction previously not present or surgical breast implants, and have read section 101.9(4) of USA Boxing Official Rules pertaining to my present condition. I have carefully read this Release of Liability. I fully understand its contents, I am aware that this is a release of liability. I sign of my own free will. Participant s Signature Date: Signature of Parent/Guardian (if under 18 years of age): Address/City/State/Zip

6 ATHLETE ENTRY FORM: CONSENT FOR SOMEONE ELSE TO AUTHORIZE TREATMENT (page 4 of 4) As the parent or legal guardian of, I hereby authorize and give my consent for any emergency medical, surgical or dental treatment for my child (listed above), should it be deemed advisable by a qualified medical doctor or dentist. Mr. & Mrs., coach or another responsible adult escort is authorized to act on my behalf should a medical/dental emergency arise while participating in the 2015 National Title Boxing Tournament. I understand this is to avoid undue delay and assure prompt attention/treatment and that only a licensed and qualified medical doctor/dentist will be engaged for such an emergency. During this period, the parent or legal guardian of the above named child will be at the following location: Signature: Tele: Address. City: State: Zip:. . I solemnly swear or affirm that the answers I have made to each and all of the questions on the form are complete and true to the best of my knowledge and belief. Participant or Signature of Parent/Guardian (if under 18 years of age) Date

7 2017 NATIONAL TITLE BOXING TOURNAMENT Sponsored by Title Boxing HOT SPRINGS NATIONAL PARK RULE & REGULATIONS Invitation/Entry Limitations: Invitation is extended to ALL team coaches. The coach is required to be a United States Amateur Boxing certified coach, with updated Pass Book, duly registered in his respective United States Amateur Boxing Association. Female weight classes are in accordance with USA Boxing rules. Equipment & Apparel Mouthpiece: All boxers are required to wear an individually fitted mouthpiece. Referees shall disqualify boxers who enter the ring with anything other than a fitted mouthpiece. Headgear: USA Boxing approved competitive headgear is mandatory for all contestants. No-Foul Protectors: USA Boxing approved no-foul protectors are required for all male boxers. Boxing Shirts: Boxers are required to wear a boxing shirt (sleeveless) while competing in the tournament. Grooming Boxers must be CLEAN SHAVEN before the weigh-ins and tournament. A neatly trimmed mustache is permissible. Hair must be cut in such a manner as not to interfere with the vision of the boxer. Sideburns are not permitted to extend below the earlobe. Boxers who do not report to the weighins groomed, as required, will be denied permission to weigh-in. Medical Medical Authorization Forms: Coaches are responsible for bringing a signed medical treatment authorization form for each boxer under the age of 18 years (included in this packet). Coaches are required to keep these treatment forms on site at all times during the tournament for quick availability. Officials Boxing officials, judges, referees and timekeepers are invited to officiate at this tournament. Officials registration applications must include their United States Amateur Boxing registration number. All cities are encouraged to bring volunteer timers, judges and referees. Referees, judges and timekeepers in all sanctioned United States Amateur Boxing competitions shall be dressed in a white shirt, black trousers and boxing shoes without heels. Judges and officials must have current certificates in their possession for Team Representation Boxers shall be required to represent the club in which they are registered. United States Amateur Boxing Passbooks or AIBA Passbooks for out of non-usa boxers All boxers are required to present their United States Amateur Boxing Passbook prior to being permitted to weigh-in. Out of State Boxers will NOT be permitted to register for United States Amateur Boxing Passbooks at weigh-ins. United States Amateur Boxing Passbooks must be secured from the boxer s United States Amateur Boxing Association district. Parking Free Complimentary Parking available, but space is limited.