STATE OF MISSOURI DIVISION OF PROFESSIONAL REGISTRATION

TICKET INVENTORY
Must be submitted to the Office of Athletics with the permit application.
PROMOTER PROMOTERS LICENSE NUMBER

OFFICE OF ATHLETICS P.O. BOX 1335 JEFFERSON CITY, MO 65102 TELEPHONE (573) 751-0243 FAX (573) 751-5649

NAME OF VENUE

SEATING CAPACITY

TICKETS PRINTED, BY DENOMINATION TICKET VALUE

(FACE VALUE OF TICKET)

NUMBER OF TICKETS
(OF THE VALUE AT LEFT)

NUMBER COMPLIMENTARY
(OF THIS VALUE)

NUMBER OF UNSOLD TICKETS

(USE AT EVENT ONLY)

TOTAL TICKETS PRINTED You must attach a copy of your printers invoice. REQUIREMENTS OF PROMOTER REGARDING TICKETS (REVIEW 20 CSR 2040-3.011 FOR ENTIRE RULE REQUIREMENTS) Complimentary tickets for more than four (4%) of the seats in the house require written authorization. Complimentary tickets must say complimentary on the ticket and state what its value would have been if it had been purchased. Tickets must have a price, name of the promoter and date of the contest, even if they are complimentary. Promoters must provide a credential, in lieu of a ticket to: Contestants, Seconds, and Managers engaged in bouts that are part of the contest.

The following individuals may be admitted to the event without tickets: Employees of the promoter and the venue necessary to produce the event.

The following individuals must be admitted to the event without tickets: The Director of the Division of Professional Registration, the Executive Director, Administrator, and Inspectors of the Office of Athletics, on-duty emergency medical service providers, firefighters, and police officers, and other individuals authorized by the Office of Athletics assigned to work the event, including referees, judges, timekeepers, the ringside physician.

I certify (or declare), under penalty of perjury, that I have read the foregoing ticket inventory, and that all answers given are my own; that all the answers are true of my knowledge; further, I understand and agree that any misstatement of a material fact in this ticket inventory will constitute grounds for discipline of my license.

PROMOTERS SIGNATURE

DATE

MO 375-0302 (9-06)