Non-Competitors License Application

Corners License Application

Combat Sports Authority of Maine
Fee: $30.00. All licenses expire on 6/30/2025
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CornerJudgeRefereePhysicianTimekeeper
Full Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Team (school) Name
I hereby verify that the information on this license application is TRUE. I further agree that the Combat Sports Authority of Maine may use any film, photograph, or other material in which I appear as the Authority deems appropriate.
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Date

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Date

My Products*

Non-Competitors License

$30.00 Quantity

Total

$0.00

Corners License Application