For your convenience, print and send in this form.
Please make checks payable to:
Charlotte Boxing Academy

Given by (Mr.) (Mrs.) _____________________________________________
Address _______________________________________________________
City ________________________ Sate _____ Zip _____________________
Apt.# ______________ Phone ( ________ ) ___________________________

Amount: _________________

Please send check or money order to:

CHARLOTTE BOXING ACADEMY
407 EAST 36TH STREET
CHARLOTTE, NC 28205
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