Form DOS-2068-F-A "National Mixed Martial Arts Identification Application" - New York

What Is Form DOS-2068-F-A?

This is a legal form that was released by the New York State Department of State - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the New York State Department of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DOS-2068-F-A by clicking the link below or browse more documents and templates provided by the New York State Department of State.

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Download Form DOS-2068-F-A "National Mixed Martial Arts Identification Application" - New York

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National Mixed Martial Arts Identification Application
Select Type (Check one only):
Professional
Amateur
To apply for an ASSOCIATION OF BOXING COMMISSIONS Mixed Martial Arts National Identification Card please complete the following:
FIRST NAME: _______________________________ LAST NAME: ________________________________ MIDDLE: ____________________
DATE OF BIRTH: _____/_____/_____
LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: ________
ADDRESS: _________________________________ CITY: __________________________________ STATE: ___________ ZIP: __________
HEIGHT: _______________ WEIGHT: _______________ HAIR COLOR: _______________ EYE COLOR: _______________
ALSO KNOWN AS: ___________________________________________________________________________________________________
PHONE (______) __________________ E-MAIL ADDRESS: __________________________________________________________________
BIRTHMARKS, SCARS OR TATTOOS: ___________________________________________________________________________________
TERMS AND CONDITIONS:
1.
Illegible applications will not be accepted. PLEASE PRINT LEGIBLY.
2.
The first and last name supplied must match the identification of the applicant. Additional names should be included in the Also Known As
line.
3.
National MMA ID Card will not be issued unless an accurate and truthful application form is completed in its entirety. Incomplete forms
will not be accepted.
A color photo including a true likeness of the applicant must be included with the application. The photo shall be of “Passport” type
4.
including a clear image with a blank background. No glasses, hats, or other adornments that will obstruct the view of the applicant. (Color
digital photos are acceptable).
5.
Two forms of valid identification (of which one must include a photo of the applicant) must be included with the application (color digital
copies are acceptable). Accepted forms of identification will include; but not be limited to driver’s license, passport, state issued
identification, etc.
6.
The applicant understands that s/he will not be permitted to compete without a National MMA ID Card.
7.
The applicant understands that the ABC in cooperation with the State Athletic Commission will settle any and all disputes with regards to
violations of these terms and conditions for the National MMA ID Card. The ruling of the ABC is final and binding on all parties.
8.
The applicant agrees to abide by these and any other terms and conditions, rules and regulations set forth by the ABC and the State
Commission.
9.
The applicant understands and agrees that the ABC reserves the right to amend the terms and conditions for issuing the National MMA
ID Card.
I certify that I have read and understand the terms and conditions pertaining to the application for a National MMA ID Card, that all information
given is my own, is true and correct to the best of my knowledge. I further understand and agree that false, misstatements or incomplete
information on the application will constitute grounds for revoking or denial of the National MMA ID Card, and subject me to a one year suspension
at the discretion of the ABC or the State Commission.
APPLICANT SIGNATURE: ________________________________________________________________ DATE: _______________________
Email completed applications and supporting documents to
NYSAC@DOS.NY.GOV.
Upon approval of application the applicant will be issued a National ID Number and will be included in the ABC National MMA Database Registry
operated by Mixed Martial Arts LLC. The applicant will receive their National MMA ID Card by US Mail in four to six weeks.
DOS-2068-f-a (Rev. 08/16)
Page 1 of 1
National Mixed Martial Arts Identification Application
Select Type (Check one only):
Professional
Amateur
To apply for an ASSOCIATION OF BOXING COMMISSIONS Mixed Martial Arts National Identification Card please complete the following:
FIRST NAME: _______________________________ LAST NAME: ________________________________ MIDDLE: ____________________
DATE OF BIRTH: _____/_____/_____
LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: ________
ADDRESS: _________________________________ CITY: __________________________________ STATE: ___________ ZIP: __________
HEIGHT: _______________ WEIGHT: _______________ HAIR COLOR: _______________ EYE COLOR: _______________
ALSO KNOWN AS: ___________________________________________________________________________________________________
PHONE (______) __________________ E-MAIL ADDRESS: __________________________________________________________________
BIRTHMARKS, SCARS OR TATTOOS: ___________________________________________________________________________________
TERMS AND CONDITIONS:
1.
Illegible applications will not be accepted. PLEASE PRINT LEGIBLY.
2.
The first and last name supplied must match the identification of the applicant. Additional names should be included in the Also Known As
line.
3.
National MMA ID Card will not be issued unless an accurate and truthful application form is completed in its entirety. Incomplete forms
will not be accepted.
A color photo including a true likeness of the applicant must be included with the application. The photo shall be of “Passport” type
4.
including a clear image with a blank background. No glasses, hats, or other adornments that will obstruct the view of the applicant. (Color
digital photos are acceptable).
5.
Two forms of valid identification (of which one must include a photo of the applicant) must be included with the application (color digital
copies are acceptable). Accepted forms of identification will include; but not be limited to driver’s license, passport, state issued
identification, etc.
6.
The applicant understands that s/he will not be permitted to compete without a National MMA ID Card.
7.
The applicant understands that the ABC in cooperation with the State Athletic Commission will settle any and all disputes with regards to
violations of these terms and conditions for the National MMA ID Card. The ruling of the ABC is final and binding on all parties.
8.
The applicant agrees to abide by these and any other terms and conditions, rules and regulations set forth by the ABC and the State
Commission.
9.
The applicant understands and agrees that the ABC reserves the right to amend the terms and conditions for issuing the National MMA
ID Card.
I certify that I have read and understand the terms and conditions pertaining to the application for a National MMA ID Card, that all information
given is my own, is true and correct to the best of my knowledge. I further understand and agree that false, misstatements or incomplete
information on the application will constitute grounds for revoking or denial of the National MMA ID Card, and subject me to a one year suspension
at the discretion of the ABC or the State Commission.
APPLICANT SIGNATURE: ________________________________________________________________ DATE: _______________________
Email completed applications and supporting documents to
NYSAC@DOS.NY.GOV.
Upon approval of application the applicant will be issued a National ID Number and will be included in the ABC National MMA Database Registry
operated by Mixed Martial Arts LLC. The applicant will receive their National MMA ID Card by US Mail in four to six weeks.
DOS-2068-f-a (Rev. 08/16)
Page 1 of 1