Confidential Charitable Fund Request Application – Association of Boxing Commissions

Application Date *

Name of Requestor or Organization *

Contact Name *

First

Last

Day Phone

Mobile Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

AMOUNT REQUESTED *

Please describe your involvement with Combative Sports *

What is the intended use of the Funds? *

SS# or TIN# *

If an Organization, please attach your federally-issued tax-exempt status letter and provide the names of the members of your Board of Directors *

Supporting Document

Name

Note: To qualify, a combative sports fighter must not have been active for the past 12 months and all
applications must be received by June 30.

Requests granted only for former fighters retired from the industry who have direct needs (medical, housing, survival, etc)