Professional Boxer Weight Waiver.Pmd

PROFESSIONAL BOXER WEIGHT WAIVER State Form 54124 (R2 / 3-11) INDIANA GAMING COMMISSION

EVENT INFORMATION Event permit number Event location Event date (month, day, year)

PROFESSIONAL BOXER INFORMATION Name of professional boxer License number Federal Identification number

Official weight of professional boxer Official weight of opponent Maximum allowable weight difference Official weight difference

OFFICIAL COMMISSION RULE ON WEIGHT CLASSIFICATIONS Pursuant to the rules and regulations of the Indiana Gaming Commission, the classification in weight schedule shall be as follows: (1) Mini flyweight up to 105 pounds. (2) Light flyweight over 105 to 108 pounds. (3) Flyweight over 108 to 112 pounds. (4) Super flyweight over 112 to 115 pounds. (5) Bantamweight over 115 to 118 pounds. (6) Super bantamweight over 118 to 122 pounds. (7) Featherweight over 122 to 126 pounds. (8) Super featherweight over 126 to 130 pounds. (9) Lightweight over 130 to 135 pounds. (10) Super lightweight over 135 to 140 pounds. (11) Welterweight over 140 to 147 pounds. (12) Super welterweight over 147 to 154 pounds. (13) Middleweight over 154 to 160 pounds. (14) Super middleweight over 160 to 168 pounds. (15) Light heavyweight over 168 to 175 pounds. (16) Cruiserweight over 175 to 200 pounds. (17) Heavyweight over 200 pounds. Notwithstanding the aforementioned weight categories, a one (1) pound weight allowance is permissible, without a penalty, for non-championship bouts.

Pursuant to the rules and regulations of the Indiana Gaming Commission, no bout may be scheduled and no professional boxer may engage in a bout between professional boxers in different weight categories, without the approval of the chief commission representative, if the difference in weight between the professional boxers in different weight categories exceeds the allowance shown in the following schedule: (1) Up to 118 pounds not more than 3 pounds. (2) Over 118 to 130 pounds not more than 4 pounds. (3) Over 130 to 140 pounds not more than 5 pounds. (4) Over 140 to 175 pounds not more than 7 pounds. (5) Over 175 to 200 pounds not more than 12 pounds. (6) Over 200 pounds no limit. PROFESSIONAL BOXER WEIGHT WAIVER

I release and forever discharge the state, the Indiana Gaming Commission, and its employees and agents from any liability to me and my heirs, administrators, executors, and assigns for any harm, monetary or otherwise, that may arise out of or by reason of any act or omission relating to this waiver. I am voluntarily waiving the State of Indiana’s statutes and administrative rules which forbid bouts where the difference in weight between the fighters exceeds the provided allowance. I have completed and am signing this Waiver in a sober and informed condition. I have completed and am signing this Waiver without reservation and without being forced, coerced, or encouraged to do so by any person. I understand the risks of participating in a bout where the fighters’ weights are outside of the provided allowance and am still willing to participate.

Signature of professional boxer Printed name of professional boxer Date (month, day, year)

Signature of event promoter Printed name of event promoter Date (month, day, year)

Signature of chief commission representative Printed name of chief commission representative Date (month, day, year)