NASA Power Sports & High School Power Press
American and World Record Application Only
Copy and Paste This Completed Form To Your E-mail and Submit To:
Robbin Hedrick-TX - Power Sports & HS Power Press Records Chairman
E-mail - Power Sports & Power Press Records ONLY! All others will be discarded.
All Records Must be submitted within 14 days of the date of the meet to be valid. Any Record Application received after 14 days MAY be refused. These forms MUST be filled out COMPLETELY. ANY blank sections may result in the record form being discarded.
NOTE: A separate form MUST be used for each and every record that you break. One Record Per Form!
Please Copy and Paste to E-mail
First Name- ______________________ Last Name-________________________ Date of Record-______________
Email-__________________________________________ Phone :(_____) ________________ Age:______
Wt. Class-_______ Name of Meet Where Record was broken -________________________________________________
Meet Director-_______________________________ Were you Drug Tested- Yes NO
Check One ____ Male Lifter ____ Female Lifter
Type of Record Broken (please indicate) - _____ American _____ World (Only at National Events)
Division you were entered in when Record was set? You MUST be entered in that division(s).
Please Place an "X" indicating the Division(s) you were entered in during the meet.
Pure Open Novice Police, Fire & Military Teenage High School Junior Intermediate Sub Masters 1
Sub Masters 2 Sub Masters Pure Masters 1 Masters 2 Masters 3 Masters 4 Masters 5 (80+) - Masters Pure
My Record was set in the following Power Sports & Power Press portion of the meet (check one): (This is Power Sports & Power Press Record Application ONLY)
__Power Sports __HS Power Press (Total Only)
I broke this Record in the following lift (check one):
Curl-______ Bench Press______ Deadlift ______ Total_______ (HS Power Press consists of Total Only)
Total Kgs lifted for this Record-________kgs (This MUST be in Kilos or this record form is Invalid)
I certify that the above information is true and accurate. I realize that if this information is not true and accurate the record I am applying for will be forfeited.
I also realize that I have a maximum of 14 days from the date of the meet to submit this application to the appropriate Records Chairperson.
I also understand that if this application is not received within 30 days my record will become null and void, no exceptions.
I also understand that I must submit one single application PER record broken. Signed (typed)-______________________________________ Date-_________________