MMA, Boxing or Kickboxing Event Detail Form

Your request will be processed in the order it was received. All items must be received at least seven business days before the event is held.

Please contact the Iowa Department of Inspections, Appeals, and Licensing if you have questions or concerns.

Basic Information

Promoter Name

Promoter Contact First Name

Promoter Contact Last Name

Promoter Email

Promoter Phone Number

Venue Information

Venue Name

Venue Address 1

Venue Address 2

City

State

Zip Code

Event Date

(Click twice on the month and year at the top of the calendar to change the year.)

Event Time

Weigh-In Details

Weigh-in Venue Name

Weigh-in Venue Address 1

Weigh-in Venue Address 2

City

State

Zip Code

Weigh-in Date

(Click twice on the month and year at the top of the calendar to change the year.)

Weigh-in Time

Medical Information

Title

Physician First Name

Physician Last Name

Physician Phone Number

Has the physician previously submitted licensing information to DIAL?

Other licensing information

Upload Physician License (optional)

One file only. 250MB limit.

Click Here to Upload

Medical Service Provider (Ambulance Service).

Upload Medical Service Contract (optional)

One file only. 250MB limit.

Click Here to Upload

Assigned EMT Name(s)

Security Information

Security Firm Name

Security Firm Contact First Name

Security Firm Contact Last Name

Security Firm Phone Number

Upload Security Firm Contract (optional)

One file only. 250MB limit.

Click Here to Upload

Cleaning Services

Cleaning Service Name

Cleaning Service Representative First Name

Cleaning Service Representative Last Name

Cleaning Service Representative Phone Number

Insurance and Bond Information

Insurance Policy Number

Upload Insurance Policy and Claim Form (required)

250MB limit.

Click Here to Upload

Upload Evidence of a $5,000 Bond (optional)

One file only. 250MB limit.

Click Here to Upload

Other Information

Please attach any other information and/or documentation you find necessary with your application (optional)

One file only. 250MB limit.

Click Here to Upload