IAAFFORM:WRRoad1/3ApplicationforaWorldRecordROADRUNNINGEVENTThisformmustbecompletedanddispatchedwithin30daysoftheWorldRecordperformance(cf:Rule260.4)to:INTERNATIONALASSOCIATIONOFATHLETICSFEDERATIONS17,ruePrincesseFlorestine,BP359,MC98007,MONACOCedexAPPLICATIONISHEREBYMADEFORTHERATIFICATIONOFTHEFOLLOWINGRECORD,INSUPPORTOFWHICHTHEBELOWINFORMATIONISSUBMITTED:(Pleasetypeoruseblockcapitals,tickwhereappropriate.)APPLICATIONDATAEvent(e.g.15km,Marathon):MenWomenRecordTimeClaimed(e.g.41:13,2:03:38):FullNameofAthlete:CountryofAthlete:ForRelayEvents,thefullnamesofallteammembers,intheorderofrunning:NameofCompetition:DateofEvent:TimeofEvent:City/Course:Country:RESULTSOFCOMPETITIONNameCountryResult1st:2nd:3rd:STARTERIcertifythatthestartoftheracewasinaccordancewithIAAFRules.Starter:Signature:FULLYAUTOMATICTIMING(ifapplicable)MakeofTimingDevice:OfficialTimeRecorded:ChiefPhotoFinishJudge:Signature:IAAFFORM:WRRoad2/3TRANSPONDERTIMING(ifapplicable)TypeandMakeofTransponder:OfficialTimeRecorded:ChiefTransponderTimingJudge:Signature:HANDTIMING(ifapplicable)I,theundersignedofficialtimekeeperoftheeventmentionedonthisform,doherebycertifythatthetimesetoppositemysignaturewastheexacttimerecordedbymywatchandthatthewatchusedbymehasbeencertifiedandapprovedbymyNationalFederation.Time:Name:Signature:Time:Name:Signature:Time:Name:Signature:IconfirmthattheaboveTimekeepersexhibitedtheirwatchestomeandthatthetimeswereasstated.ChiefTimekeeperorReferee:Signature:COURSEI,an“A”or“B”gradeIAAF/AIMSapprovedcoursemeasurer,herebycertifythatIhavemeasuredthecourseoverwhichthiseventwasheld.MeasuredRaceDistance:Thestartandfinishpointsofthecourse,measuredalongatheoreticalstraightlinebetweenthem,arenotfurtherapartthan50%oftheracedistance.YesNoThedecreaseinelevationbetweenthestartandfinishdoesnotexceedoneinathousand,i.e.1mperkm.YesNoMeasurer:Qualification:Signature:VALIDATIONI,an“A”or“B”gradeIAAF/AIMSapprovedcoursemeasurerinpossessionofthecompletemeasurementdataandmaps,certifythatthecoursemeasuredwasthecourserunbytheathlete.Measurer:Qualification:Signature:IAAFFORM:WRRoad3/3DOPINGCONTROLI,amemberoftheDopingCommitteefortheCompetition,certifythatasampleforadopingtestwasobtainedinaccordancewithIAAFRulesfromtheabovementionedathleteinmypresenceanddispatchedtothefollowingaccreditedlaboratory:NOTE:Forrelays,samplesmustbeobtainedfromALLmembersoftheteam.DateandTimeofDopingSampleCollection:TestingLaboratory:DopingControlOfficer:Signature:GUARANTEEBYREFEREEIherebycertifythatalltheinformationrecordedonthisformisaccurate,thattheofficialsconductingtheCompetitionweredulyqualifiedandthattheappropriateIAAFCompetitionRuleswerecompliedwith.Referee:Signature:THEFOLLOWINGMUSTBEENCLOSEDWITHTHISAPPLICATIONTheprintedprogrammeoftheCompetition,thecompleteresultsoftheeventincludingthePhotoFinishandZeroTestimageinthecaseofarecordwhereFullyAutomaticTimekeepingwasinoperation,Judges’ScoreSheet,OfficialResults,MeasurementandRe-measurementReport,DopingControlForm.AdditionalInformationForHistoricalPurposesWeatherConditions:IntermediateTimes:IfAvailable:VideooftheRecordforIAAFUsePhotographoftheAthletePressCuttingsRECOMMENDATIONBYIAAFMEMBERFEDERATIONTheundersignedIAAFMemberherebycertifiesthatitissatisfiedwiththeaccuracyofthisapplicationandrecommendsitforacceptance:IAAFMemberFederation:President:(Name)Gen.Sec.:(Name)Signature:Signature:IAAFAPPROVALIAAFPresidentDateIAAFGeneralSecretary
