Athletes Data And Agree Record Application Template
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1Athletes Details
Male
Female
Name__________________________________________________________________________
Full Mailing Address________________________________________________________________________________________
City________________________________________State_________________________Zip Code_________________________
H Phone(____)_______________________Cell(____)_____________________E-Mail____________________________________
National Federation APF
AAPF
Both
Registration Number________________________________
Date of Birth_______________________________Age Last Birthday_____________________________________
Details of Record Being Claimed
Name of Competition____________________________________________Location_____________________________________
Date__________________________________ Competition Body Weight ___________kg Weight Class ___________kg
Category and Division
APF
WPC
Full Meet
Raw
SP (single ply)
AAPF
AWPC
Bench Only
CR (classic raw)
MP (multi ply)
Deadlift Only
Open
Teenage 13-15
16-17
18-19
Junior 20-23
Master 40-44
45-49
50-54
55-59
60-64
Submaster 33-39
65-69
70-74
75-79
80 up
Enter all your Lifts – Enter in kilos only
Record Claim
First Attempt
Second Attempt
Third Attempt
Fourth Attempt
SQUAT
kg
kg
kg
kg
BENCH PRESS
kg
kg
kg
kg
DEADLIFT
kg
kg
kg
kg
TOTAL
kg
World & National Record Certification
World Records can be set at National, and International competitions. According to the AWPC/AAPF Rules no record will be considered unless entered on this
Records Claim Form, which must be duly signed by the Athlete, the Referees adjudicating the lift(s), the Official Weigher and the appointed Technical Officer of the
Competition. Certified platform scales must have been used at the weigh in and a copy of the certification certificate attached to this claim. The bar and weights must
have been weighed before the competition or immediately after the Record Attempt. The Athletes costume and personal equipment must have been inspected and
conform to the requirements of the AWPC/AAPF Rules. A minimum of two World Referees affiliated to the AWPC/AAPF is required to certify a Record.
We have witnessed the correct performance of the above lift(s) and have checked the weight of the bars and discs. The lifter weighed in within 24 hours of the
competition. The lifter and his/her attire have been checked and conform to the requirements of the AWPC/AAPF Rules. We are current members in good standing
with the American Powerlifting Federation.
Signature_______________________________Signature_____________________________Signature_______________________
Print name_____________________________Print name____________________________Print name_______________________
Technical Officer Signature_______________________________Official Weigher Signature________________________________
I have checked all data and agree all is correct: Athletes Signature_____________________________Date____________________
Mail to: APF Headquarters, 505 Westgate Drive, Aurora, IL 60506 USA
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