Name *

First Name

Last Name

Sponsorship Level *

Heavyweight – Member $7,500 | Non-Member $8,000

Middleweight – Member $4,750 | Non-Member $5,000

Welterweight – Member $3,250 | Non-Member $3,750

Member *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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