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ABN 29505477447

BOXING TAS INCORPORATED

CLUB/GYM AFFILIATION FORM

Please read both sides of this form carefully. Complete all sections, and submit with the fee to

Boxing Tasmania (Inc),

133 Gordons Hill Rd

LINDISFARNE 7015

Reg No:

 

 

Receipt:

 

 

Date reg:

 

 

 

 

 

 

 

 

 

 

Any clubs, gyms or organisations which are located in Tasmania may affiliate with Boxing Tasmania (Inc), subject to certain conditions.

Boxers cannot represent a club/gym or other organisation unless affiliated with Boxing Tasmania (Inc)

SECTION 1 - DETAILS OF CLUB/GYM SEEKING AFFILIATION

 

Name of club/gym

 

 

 

Actual address

 

 

 

Postal address (if different)

 

 

 

 

Fax number

Phone number

 

 

 

 

                                                                   

       Mobile Phone No:

 

Email address

http://

 

 

Internet website address

http://

 

 

Association Incorporation Number (if applicable)

 

 

 

Australian Business Number (ABN) (if applicable)

 

 

SECTION 2 - BOXING COACHING

 

 

Does your club/gym/organisation conduct boxing classes?

 

 

 

Names of coaches conducting boxing classes:

 

 

 

 

 

Are your boxing classes available to the public?

 

 

 

List club/gym on our website directory? (Yes/No)

 

 

 

Boxing training days and times

 

 

 

 

 

SECTION 3 - BOXING TAS NEWSLETTER

 

 

Request for a copy of Boxing Tasmania Newsletter

 

 

SECTION 4 - DECLARATION

 

 

Name of person making this application

 

 

 

Position in organisation

 

Phone

 

“I certify that I have the authority to make this application on behalf of the above club/gym and I declare that all boxing training and boxing sparring conducted at the

club/gym will comply with the policies of Boxing Australia (Inc) as set out overleaf and as updated from time to time by notice delivered to the organisation.

 We hereby declare that, if affiliated as a club/gym we agree to be bound by the present and future constitution and bylaws of Boxing Tasmania (Inc.)”

 

Signature

 

Date