Form Pa-611-020 - Application For Licensure As Manager Page 2

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NOTICE TO MANAGERS
1. Managers must list all boxers currently under contract in space provided below. Verbal agreements are not recognized.
2. Boxer/Manager Contracts must be filed with the Department to be valid.
3. Managers and boxers must keep their license current to insure the continued validity of contract.
BOXERS CURRENTLY UNDER CONTRACT
BOXERS PREVIOUSLY
NAME
UNDER CONTRACT
I declare under penalty of perjury under the laws of the State of Washington, that all answers given on this application are true
and correct. Further, I understand that any misstatement of fact on this application will constitute grounds for disciplinary action.
Signature of Applicant ___________________________________________________Date _______________________
PA-611-020 MGR. LIC. APP. (R/11/99)FM/W Page 2 of 3

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