Promoter Event Contract With Boxing Or Martial Arts Participant And/or Manager Form - 1999 Page 2

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Affidavit of Professional and/or Amateur Ring Record
I, __________________________________________________________________ hereby attest that the following
is an accurate, true and complete statement of the Boxing or Martial Arts participant’s ring record:
Profesional Ring Record
Wins ______________Losses ______________ Draws _______________
Amateur Boxing Ring Record
Wins ______________Losses ______________ Draws _______________
I have carefully read the information provided herein and pursuant to RCW 9A.72.085, I declare under
penalty of perjury under the laws of the state of Washington that the information provided by me is true
and correct. Should I furnish any false information, I hereby agree that such act shall constitute cause for
the denial, suspension, or revocation of any license defined in RCW 67.08.
______________________ / ___________________________ __________________ , _______ _______________
Printed Name of Promoter
Signature
City
State
Date
______________________ / ___________________________ __________________ , _______ _______________
Printed Name of Participant
Signature
City
State
Date
______________________ / ___________________________ __________________ , _______ _______________
Printed Name of Manager
Signature
City
State
Date
PA-611-027 BOXER/MGR-PROMO CONT (R/12/99)FM/W Page2 of 2

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