American record application form - USA Powerlifting

Drug Testing Officer Signature _____________________________________Urinalysis BloodSend test results to the National Office.(circle one)_____________________________________________________________________________________For Meet Director only:______ All meet equipment was measured prior to the competition and was found to be within the rules.______ All Plates, bars, and collars were weighed prior to the meet and were found to be within the rules.(All competition plates, bars, and collars must be within 0.25% of the face value.)Meet Director’s Signature_______________________________________________________________Only when the weight of the plates, bars, and collars are not withinrule limitations, fill out the following: Weight of each plate, bar, andcollars.SQUATBENCH DEADLIFTBAR ____________ ____________ ____________COLLARS ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________PLATE ____________ ____________ ____________TOTAL ____________ ____________ ____________Addition checked by:Chairman of the JuryHead Referee in ChargeAmerican Records established in theTeen, Junior, Collegiate and Masterdivisions will be drug tested at thecombined discretion of (3) officials: theMeet Director, the Head Referee inCharge and the USAPL President. In theabsence of the President, the thirdofficial will be selected by the followingorder: 1st - The Drug Testing Officer;2nd - The USAPL State Chair; 3rd -another Referee adjudicating thecompetition. All of the aforementionedofficials should have attained theNational level referee ranking. The (3)signatures of these officials below willconstitute a waiver of the drug testingrequirement for this particular AmericanRecord Application. All Open AmericanRecords continue to require 100% drugtesting.___________________________________Meet Director___________________________________Head Referee in Charge___________________________________USAPL President (or selected official)Signature:___________________________________________________________