(416) 426-7250 | info@boxingontario.com

Boxing Alberta - Clubs

01. Registrant InformationRegistrants
02. Confirmation & PaymentConfirmation
03. ReceiptReceipt

Clubs - to be completed by club admin or club registrar only

CLUB INFORMATION

Name of Club (My club is missing ) *

Club Address *

Club City *

Club Postal Code *

Club Phone # * - International Number

Club Email Address * Opt in to emails

Club Website

Do you require additional insured to be named on your certificate? If so, please indicate the legal name, address, contact name & e-mail(s) here:

ADMINISTRATIVE CONTACT

Full Name *

Cell Phone - International Number

Email Address * Opt in to emails

Street Address *

City *

Province *

Postal Code *

LEAD CLUB COACH

Full Name *

NCCP # *

Cell Phone - International Number

Email Address * Opt in to emails

Street Address *

City *

Province *

Postal Code *

CLUB MAIL

Where do you want club mail to be sent? *

Where do you want club email to be sent? *

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