NASA – TEXAS State Record Application

All Records Must be submitted within 15 days of the date of the meet to be valid. Any Record Application received after 15 days will be refused.

A form must be mailed for each record that you break.

First Name- ______________________ Last Name-_____________________

Date of Record-________________

Email-_______________________________ Phone :(_____) ________________ Age:______  

Wt. Class-____ Division-______________ Name of Meet-_______________________  

Male________Female________

Meet Director-______________________ Were you Drug Tested- Yes NO  

My Record was set in the following portion of the meet (check one):

__ Power Sports __ Powerlifting __Equipped BP __Unequipped BP

__Unequipped Powerlifting __Push Pull

I broke this Record in the following lift (check one):

Curl__ Squat__ Bench Press__ Deadlift__ Total__

 Total Kgs lifted for this Record-______kgs

 
I certify that the above information is true and accurate. I realize that if this information is not true and accurate the record I am applying for will be forfeited. I also realize that I have a maximum of 30 days from the date of the meet to submit this application to the appropriate Records Chairperson. I also understand that if this application is not received within 30 days my record will become null and void, no exceptions. I also understand that I must submit one single application PER record broken.

Signed-____________________________ Date-_________________

Email this form to :  RecordChairman@rocketmail.com

Or

Mail it to:

Clyde Lynn
6006 85^th St
Lubbock, TX 79424