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1 Gene Lewis Boxing Club, Inc. presents The 39th Annual Gene Lewis Invitational Boxing Tournament November 6, 7, 8, 2014 Thursday - Friday - Saturday Bouts Begin Thursday and Friday at 7:00 pm Saturday at 1:00 pm Broadway Recreation Center 59 East Broadway Mesa, Arizona $7.00 Admission Entry Forms and Information available at: Gene Lewis Boxing Club gym: (480)

2 GENE LEWIS BOXING CLUB, INC. P.O. BOX 930, MESA, AZ th ANNUAL Mesa Invitational Amateur Boxing Tournament NOVEMBER 6, 7, 8, 2014 MEN S DIVISION Registration Form ENCLOSE $12 REGISTRATION FEE WITH EACH FORM NO EXCEPTIONS - NO REFUNDS CIRCLE DIVISION ENTRY AGE: 9 & AGE: 11 & AGE: 13 & (Females Same as Males Weights) AGE: 15 & (Females up to 189+) MALE FEMALE FEMALE WOMEN S and GIRLS DIVISION (Girls subject to number of entries) Novice (if available entries) Name Age Weight Representing Boxing Club Address City State Zip Passbook No. Experience: Won: Lost: Major tournaments the boxer has won: RETURN APPLICATIONS TO: GENE LEWIS BOXING CLUB P.O. BOX 930 MESA, AZ 85211

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4 GENE LEWIS BOXING CLUB, INC. 39th MESA INVITATIONAL AMATEUR BOXING TOURNAMENT TIME: Tournament is scheduled for November 6, 7, 8, :00 PM THURSDAY& FRIDAY - 12:30 PM SATURDAY HEADQUARTERS: REGISTRATION INFORMATION: GENE LEWIS BOXING CLUB BROADWAY RECREATION CENTER 59 E. BROADWAY ROAD MESA, ARIZONA $12 REGISTRATION FEE ALL BOXERS MUST BE CURRENTLY REGISTERED WITH USA BOXING, INC. IN THEIR HOME STATE FOR INSURANCE AND SANCTION PURPOSES. WEIGH-INS AND PHYSICALS: THURSDAY, NOVEMBER 7-7AM TO 10AM FRIDAY, NOVEMBER 8-7AM TO 9AM SATURDAY, NOVEMBER 9-7AM TO 9AM ORIENTATION THURSDAY, NOVEMBER 7-10:00 AM TO NOON

5 WEIGH-INS: Weigh-ins are on Thursday morning (November 6) from 7:00 AM to 10:00 AM, Friday morning (November 7) from 7:00 AM to 9:00 AM and Saturday morning (November 8) from 7:00 AM to 9:00 AM. PHYSICALS: All physicals will be conducted at 5:30 PM each evening during the tournament for those participating that night. OFFICIALS: A brief officials meeting will be held before the bouts at 6:00 PM on Thursday, Friday and Saturday at 11:00am. All out-of-state officials must be registered USA Boxing and are welcome to participate. COACHES: Bring your own lock; showers are available. PAIRINGS: Pairings will be made at approximately 10:30 AM following the coaches meeting; all coaches are urged to attend. ALL MEETINGS, WEIGH-INS, PHYSICALS AND BOUTS WILL BE HELD AT THE BROADWAY RECRE- ATION CENTER, 59 E. BROADWAY (SEE MAP BELOW) LOCKERS: Bring your own lock; showers are available. USA PASSBOOK: All boxers must be currently registered with the USA BOXING INC. in THEIR APPROPRIATE STATE for insurance and sanction purposes.

6 UNITED STATES AMATEUR BOXING INC. Female Athlete Acknowledgement Name of Event: Mesa Invitational Amateur Boxing Tournament Date: November 6, 7, 8, 2014 Sanction # Sanctioned by USA Boxing, Arizona Association and United States Amateur Boxing, Inc. (Section above to be completed by Sanction Holder) Must be completed and signed by female athletes each time they complete. Name: LBC Name & #: Address: Street City State Zip Code Birth date: USA Boxing Registration # Acknowledgement I 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 (SECONDARY AMENORRHEA), RECENT BREAST BLEEDING, RECENTLY DEVELOPED BREAST MASS, RECENT BREAST DYSUNCTION PREVIOUSLY NOT PRESENT OR SURGICAL BREAST IMPLANTS, AND HAVE READ SECTION 101.9(4) OF USA BOXING S OFFICIAL RULES PERTAINING TO MY PRESENT PHYSICAL CONDITION. I FURTHER AGREE THAT I WILL IMMEDIATELY NOTIFY MY COACH, TRAINER OF OTHER LOCAL BOXING OFFICIALS IF ANY OF THE ABOVE DESCRIBED CONDITIONS SHOULD DEVELOP/APPLY AND WILL IMMEDIATELY DISQUALIFY MYSELF AND CEASE PARTICIPATION IN THE ABOVE EVENT. (SECTION 101.9(4) OF USA BOXING S OFFICIAL RULES IS INCORPORATED IN THIS ACKNOWLEDGEMENT BY REFERENCE). I, the undersigned, have read this Acknowledgement. Signed: Date: (Participant s Full Name) Signed: Date: (Participant s Legal Guardian) *REQUIRED IF ATHLETE IS A MINOR