WASHINGTON STATE RECORD APPLICATION FORM

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

Please give numbers (body weight and weights lifted) using the type of weights used
at the meet (pounds or kilos).

Name of Contest: ________________________________________________

Date of Meet: ___________________________________________________

Athlete's Name: _________________________________________________

USAPL #: __________________ Date of Birth: ________________________

Body Weight: _________ Weight Class Competing In: ________ Age: _____

Records Set

RAW ________             With Equipment _________ 

Category:

Teen 1 (14-15) ____      Teen 2 (16-17) _____      Teen 3 (18-19) ______     Junior (19-23)  ___

Open ___

Master 1 (40 -44) _____   Master 2 (45-49) _____   Master 3 (50-54) _____

Master 4  (55-59)  _____  Master 5 (60-64) _____   Master 6 (65-69) _____  Master 7 (70+)  _____

Military _________            Police/Fire __________

Special Olympics _____


Lift: Squat: _______ Bench: _________ Deadlift: ________ Total: _________

Meet Director's Signature: __________________________________________________

Meet Director's Name: _____________________________________________________