PORTLAND BOXING CLUB
MEMBERSHIP/COMPETITOR APPLICATION
Name___________________________________________________________________
Address_________________________________________________________________
City__________________________________ State_________ ZIP_________________
Telephone__________________ Age________________ DOB_____________________
Person to contact in case of emergency________________________________________
Relationship to applicant____________________ Phone__________________________
Address_________________________________________________________________
Do you have any disabilities or health risks? Yes____ No____
If yes describe fully
________________________________________________________________________
________________________________________________________________________
Are you presently taking any medications? Yes____ No____
If yes describe fully
________________________________________________________________________
________________________________________________________________________
What is your goal in regard to joining PBC (i.e. getting in shape, competing)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Do you have any experience in boxing? If yes please explain
fully____________________________________________________________________
________________________________________________________________________
________________________________________________________________________
What is your commitment level to boxing (i.e. can train once a week, four times a week,
etx)?____________________________________________________________________
________________________________________________________________________
Please tell us anything else about yourself that you feel we should know in order to
accept your application
________________________________________________________________________
________________________________________________________________________
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