IAAFFORM:WRTrack1/3ApplicationforaWorldRecordTRACKEVENTThisformmustbecompletedanddispatchedwithin30daysoftheWorldRecordperformance(cf:Rule260.4)to:INTERNATIONALASSOCIATIONOFATHLETICSFEDERATIONS17,ruePrincesseFlorestine,BP359,MC98007,MONACOCedexAPPLICATIONISHEREBYMADEFORTHERATIFICATIONOFTHEFOLLOWINGRECORD,INSUPPORTOFWHICHTHEBELOWINFORMATIONISSUBMITTED:(Pleasetypeoruseblockcapitals,tickwhereappropriate.)WorldRecordWorldJuniorRecordWorldIndoorRecordWorldJuniorIndoorRecordAPPLICATIONDATAEvent(e.g.100m,3000mSC):MenWomenRecordTimeClaimed(e.g.9.58,7:53.63):FullNameofAthlete:CountryofAthlete:DateofBirthforJuniors:DMYForRelayEvents,thefullnamesofallteammembers,intheorderofrunning(includingDOBforJuniors):NameofCompetition:DateofEvent:TimeofEvent:City:Country:NameofStadium:RESULTSOFCOMPETITIONNameCountryResult1st:2nd:3rd:STARTERIcertifythatthestartoftheracewasinaccordancewithIAAFRules.MakeofFalseStartControlDevice(ifapplicable):ReactionTime(ifapplicable):Starter:Signature:IAAFFORM:WRTrack2/3FULLYAUTOMATICTIMINGMakeofTimingDevice:OfficialTimeRecorded:ChiefPhotoFinishJudge:Signature:HANDTIMING(ifapplicable)I,theundersignedofficialtimekeeperoftheeventmentionedonthisform,doherebycertifythatthetimesetoppositemysignaturewastheexacttimerecordedbymywatchandthatthewatchusedbymehasbeencertifiedandapprovedbymyNationalFederation.Time:Name:Signature:Time:Name:Signature:Time:Name:Signature:IconfirmthattheaboveTimekeepersexhibitedtheirwatchestomeandthatthetimeswereasstated.ChiefTimekeeperorReferee:Signature:WINDMEASUREMENT(ifapplicable)TypeandMakeofWindGauge:WindSpeedintheDirectionofRunning:WindGaugeOperator:Signature:DOPINGCONTROLI,amemberoftheDopingCommitteefortheCompetition,certifythatasampleforadopingtestwasobtainedinaccordancewithIAAFRulesfromtheabovementionedathleteinmypresenceanddispatchedtothefollowingaccreditedlaboratory:NOTE:Forrelays,samplesmustbeobtainedfromALLmembersoftheteam.DateandTimeofDopingSampleCollection:TestingLaboratory:DopingControlOfficer:Signature:ATHLETICSFACILITYTheFacilityholdsacurrentvalidIAAFAthleticsFacilityCertificate:Class1Class2IndoororThecompetitionsitecompliedwiththeconditionssetoutintheIAAFCertificationSystem.TherespectivepartsoftheIAAFMeasurementReportFormareattachedtothisapplication.TechnicalManager:Signature:IAAFFORM:WRTrack3/3GUARANTEEBYREFEREEIherebycertifythatalltheinformationrecordedonthisformisaccurate,thattheofficialsconductingtheCompetitionweredulyqualifiedandthattheappropriateIAAFCompetitionRuleswerecompliedwith.Referee:Signature:THEFOLLOWINGMUSTBEENCLOSEDWITHTHISAPPLICATIONTheprintedprogrammeoftheCompetition,thecompleteresultsoftheeventincludingthereactiontimes(ifapplicable),thePhotoFinishandZeroTestimageinthecaseofatrackrecordwhereFullyAutomaticTimekeepingwasinoperation,Judges’ScoreSheet,OfficialResults,DopingControlForm,PassportcopyforJuniors.AdditionalInformationForHistoricalPurposesWeatherConditions:IntermediateTimes(ifapplicable):IfAvailable:VideooftherecordforIAAFusePhotographoftheathletePresscuttingsRECOMMENDATIONBYIAAFMEMBERFEDERATIONTheundersignedIAAFMemberherebycertifiesthatitissatisfiedwiththeaccuracyofthisapplicationandrecommendsitforacceptance:IAAFMemberFederation:President:(Name)Gen.Sec.:(Name)Signature:Signature:IAAFAPPROVALIAAFPresidentDateIAAFGeneralSecretary
