Name of licenced promoter: Telephone:
Q1. Details of proposed promotion
Date: / /
Venue: Time doors open: Time promotion starts:
Q2. Type and number of contests:
Type
Number of contests Rules used
X Boxing
X Kickboxing
X Mixed Martial Arts
X Muay Thai
X Other (specify):
Q3. Details of the main event
Contestants:
Gender:
Both contestants must be the same gender
Number of rounds: Duration of rounds: Type of contest:
Q4. Proposed Weigh-in details
Date: / / Time: Place:
Q5. Key personnel involved in the promotion
Name of the licensed match-maker: Name of the medical practitioner: Name of the licensed timekeeper/s:
Q6. Do you propose to provide any other form of entertainment at the promotion (e.g. singing, dancing)
If “Yes” please provide details:
Yes No
Q7. Please provide details of insurance that you intend to provide for professional contestants and officials, and public liability insurance (e.g. Insurance Broker, value of cover).
Promotion participant insurance:
Public liability insurance:
Please turn over to complete form
Q8. Costing details
Matchmaking: $ Purses: $ Advertising: $ Venue hire: $
Officials and doctor: $
Tax: $
Overseas contestant.
Other: $
Airfares, accommodation, etc.
Proposed Seating Prices
Ringside : $
: $
: $
: $
: $
Q9. Details of security arrangements
Security firm:
How will security officers be identified?
All security personnel must be licensed crowd controllers.
Number of security officers:
Q10. What steps will be taken to ensure the protection of officials from verbal and physical abuse and threats? (e.g. it will be a condition of entry that persons behaving in an abusive or threatening way will be ejected from the venue)
I attach the proposed fight card for the promotion including the name of each contestant’s trainer.
I attach evidence of my capacity to pay for all costs associated with the promotion
e.g. bank letter or statement, supported guarantee, bank records, or other satisfactory evidence.
I agree to be bound by any conditions attached to this permit, if approved.
Signature: Date: / /
If required, any supplementary information requested by the Board must be provided before a permit will be issued.
An application to register or re-register a contestant should reach the Board in reasonable time before the date of the contest.
International and interstate professional contestants must arrive in Victoria 24 hours before participating in a professional contest, unless the Board approves arrival within a shorter time period.
Promotion fee (based on estimation of attendance of the promotion):
$850.00 (500 or less), $2,000.00 (501 to 2000), $5,000.00 (more than 2000)
Payable by:
X Cheque
X Money order
X Credit card / Debit card
Note: Cash payments are not accepted.
If paying by credit card or debit card, please enter payment details below:
Name on card: / Card type:Card number: / Expiry: / M / M / Y / Y / CCV:
Signature of cardholder: