Bout Protest/ Review Application

Date: ______________________

Applicant: _____________________________________  VS  Opponent: ___________________________________

Address: __________________________________________________________    Zip: ______________________

Phone: _____________________________________     Email: __________________________________________

Promotion: ____________________________________   Date of Event: ___________________________________

Representative: ________________________________    Referee: _______________________________________

Other individuals involved: ________________________________________________________________________


Please include the following;
_____ Application with a detailed explanation of your protest.
_____ VHS or DVD of the bout in question for review.  DVD preferred.
_____ Protest Fee of $100.00.  This will be returned should the review be found plausible.
_____ Send to:   CSC, C/O Bout Protest, 220 E. Vine St. Dexter, MO. 63841


Please write below (use additional pages if needed) any and ALL details surrounding the events leading to your protest.  Be sure to include times, people involved, and circumstances leading to the event, to the best of your recollection:
 
(Write legibly)

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Signature: _______________________________________  Printed Name: _________________________________