OREGON STATE RECORD APPLICATION FORM

Oregon Records can only be set by Oregon residents and must be weighed
in within 2-hours of their flight.

Name of Contest: ________________________________________________
Date of Meet: ___________________________________________________
Athlete's Name: _________________________________________________
USAPL #: __________________ Date of Birth: ________________________
Body Weight: _________ Weight Class Competing In: ________ Age: _____

Records Set
Category:
Teen 1 ___
Teen 2 ___
Junior ___
Open ___
Master 1 ___
Master 2 ___
Master 3 ___
Master 4 ___
Master 5 ___
Special Olympics ___

Lift: Squat: _______ Bench: _________ Deadlift: ________ Total: _________
Meet Director's Signature: __________________________________________________
Meet Director's Name: _____________________________________________________