Application for a
Required for ALL National Records. |
Send to: CPU RECORDS CHAIRMAN Mike Armstrong 4709 Fordham Cres. SE Calgary, Alberta, T2A 2A5 |
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Please Note:
- To have your record lift(s) accepted, the lifter must: a) Submit this completed record application b) Submit a record application FEE of $75 The Record Application and Fee must be sent to the above address, postmarked within SEVEN days of the contest (or the last day of a multi-day event) or it will be rejected. |
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Name ________________________________________ Phone No. ____________________________
Address _____________________________________ City _________________________________
Province ____________________________________ Postal Code __________________________
Email ___________________________________________________ CPU card number: _________
Age ______ Date of Birth - Month _____ Day _____ Year ______ Male [ ] Female [ ]
Name of Contest _____________________________________________________________________
Location of Contest ___________________________________ Date _______________________
Meet Director__________________________________________
Lifters Weight Class _________________ Actual Body Weight _________________________
Check One: ( ) Equipped Records ( ) Unequipped Records
(Unequipped means non-supportive suit/shirt, wirstwraps, belt allowed)
Please Circle Correct Category(s)
OPEN SUB-JUNIOR JUNIOR M1(40-49) M2(50-59) M3(60-69, women 60+) M4(70+)
Please list ALL successful lifts including total, and Circle All Record Lifts
Three Lift Contest
First Attempt Second Attempt Third Attempt
Squat _________ kg Squat _________ kg Squat _________ kg
Bench _________ kg Bench _________ kg Bench _________ kg
Dead _________ kg Dead _________ kg Dead _________ kg Total __________ kg
Bench Only Contest
Bench 1 __________ kg Bench 2 __________ kg Bench 3 ___________ kg
IF POSSIBLE, ATTACH A COPY OF THE OFFICIAL RESULTS OF THE MEET SIGNED BY ALL REFEREES
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