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, 2 Leabrook, Centralia, MO 65240
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)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Signature: _______________________________________ Printed Name: _________________________________
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, 2 Leabrook, Centralia, MO 65240
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)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Signature: _______________________________________ Printed Name: _________________________________