AS OF 4-28-2009 ALL INSURANCE PAYMENTS PAID BY CHECK, MUST BE RECEIVED AND CLEARED 21 DAYS BEFORE SCHEDULED EVENT!!!

PLEASE FILL IN ALL SPACES

Promoters Full Name: _______________________________________
Address:
_________________________________________________
_________________________________________________
City: _______________________ State: _____________________ Zip:_________________
Primary Phone Number:         (________) ________-___________ Public?: Y    N
Home Phone Number:         (________) ________-___________
Fax:                         (________) ________-___________
E-Mail Address: ____________@__________________________
Web Page URL: ________________________________________


REQUESTED DATE: Month:____________________ Date:________ Year:_________
DAY OF THE WEEK: (Circle One Please) - - - Mon - Tue - Wed - Thur - Fri - Sat - Sun
Promotion Name:___________________________________________________________
Name of Event:_____________________________________________________________
Venue name and location:
_________________________________________________
_________________________________________________
CITY:___________________STATE:____________
Seating Capacity: ____________________
Number of Potential Amateur Bouts: __________
Matchmaker: ____________________________________
Does your matchmaker understand the matchmaking rules?                  YES___  NO___

How many MMA events have you Promoted?                                 __________


List two references with phone numbers:
_______________________________________________ Phone: _____________________
_______________________________________________ Phone: _____________________

Have you ever been convicted of any felony?                                 YES___ NO___
If Yes, please explain: _______________________________________________________
_____________________________________________________________

Will the event be Filmed or Video taped to Later Be Televised:         YES ___ NO___
If YES, assistance from our media relations director will be forthcoming.

Ring Announcer Name: _____________________________________________________
Ring Announcer Phone: _________________________

Please List Your Requested Officials

If you do not know any Officials please write in “TBA” (to be assigned)
All Officials must be confirmed and /or appointed prior to your event.
Your Event Representative will be assigned upon confirmation to oversee your event.

Event Representative: _____________________
Physician(s): _____________________________
       _______________________
Are they/he/she qualified/certified for BTLS (Basic Trauma Life Support) Emergencies?                         Yes ___ No____


Time Keeper: ________________________________


List 3 JUDGES with phone:
_________________________  __________________________
_________________________  __________________________
_________________________  __________________________
Have they Judged for an MMA Event before?         YES___ NO____
For whom: _______________________________________________
Please list the qualifications/experience of your JUDGES.
Are they certified by CSC or another organization?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Who are you requesting to be your Referee(s) For Your Event:
________________________________ AND ________________________________
Have they ever been REFEREE(S) an MMA Event?         YES ___ NO____

Please list the qualifications/experience of your Referee(s).
Are they certified by CSC or another organization?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The Below Information Is Be Required To Be Emailed Or Mailed To Combat Sports Commission Within 7 Days Prior To Your Event If Approved.
These answers may be left blank until you provide this information to CSC prior to your event.

INSURANCE INFO:  
If Providing “PROOF OF INSURANCE”  Fill out all information and forward a copy of your policy to CSC.
Leave blank if CSC is providing your Fighter Medical insurance under sanctioning.

What Company is Covering Your Fighters Medical Coverage:
_______________________________________________________________  CSC _______
Contact Person: __________________________ Phone: ________________
Policy Number: _________________________________________________

Coverage amounts Circle: Medical 2500   5000   10000    Death same as Medical   Deductible: 500  1000
                            
The deductible is the amount in which you, the promoter is responsible to cover,  unless a written agreement is in force prior to the event date.

What Company is covering your
Venue Liability: _______________________________  CSC _____
Contact Person: ______________________________ Phone: _______________________
Coverage amounts: _________________________________________________________
Policy Number: ______________________________
Is Combat Sports Commission listed as an Additional Insured on all  your Insurance Policies in which you
have provided proof:                                                                                                 YES___ NO ___

   If NO, CSC must be added as an additional insured on all policies in which we have not provided.  A copy of the certificate is required within 7 days of the event.                                        
     
   Additional information is required if CSC is assisting you with your venue liability insurance.  All information is required a minimum of seven (7) days prior to your event.  A staff member will be in
contact with you.

AMATEUR FIGHT CARD
This will need to be e-mailed to admin@combatsportscommission for Approval a minimum of 10 days prior to your event.  All participants you are anticipating should be submitted.  Actual bouts do not
need to be submitted until 4 days prior to the event.


Promoter Agreement - Please Acknowledge each item by initialing:
_____ Promoter has read and agrees to all requirements of sanctioning.
_____ Promoter has read and agrees to all Rules & Regulations as set forth.
_____ Promoter agrees to the submit all applicable fees within the guidelines set forth.
_____ Promoter agrees to the Following as requirements of CSC Sanctioning:
_____ Print Ads/Posters/Fliers/Event Programs: The CSC logo and name must be placed on your advertisement in a conspicuous location.
_____ Audio and / or Television: the following must be included in audio or TV Advertisement "This event is Sanctioned by Combat Sports Commission, under  the authority of the Missouri State Office
of Athletics, go to www.combatsportscommission.com for more info”

_____ As required by the Office of Athletics, YOU MUST video tape your event: Minimum of VHS, DVD is preferred. A copy must be received in the office of CSC within 10 days of your event.

_____ Send a full list of the scheduled bouts a minimum of 5 days prior to your event to; officials@combatsportscommission.com

______ As required by the Missouri State Office of Athletics, you agree to appear before their office upon written request and to answer truthfully any inquiries they make.

By signing below, the promoter agrees to the above noted items of this Sanctioning Contract.  All information provided above is true and correct and proves so by signing and printing his / her name
below.

Promoters Signature: ______________________________ Date: ___/____/____
Promoters Printed Name: ___________________________