Australian Masters Athletics Inc (AMAI)
APPLICATION FOR STATE/AUSTRALIAN RECORD VALIDATION Dec 2014 edition
(Please type or use capital letters throughout)
Name State
Address Telephone No.
Event Age Group Date of birth
Place of Competition, Nature of Meeting Date of Meeting
Time: ElectronicIf fully electronic start/finish system
Hand 1st Watch
Times:Hand Time Claimed(middle time or majority time)
2nd Watch
3rd Watch
(N.B. Express electronic times to two decimal places in the seconds, and hand times to one decimal place in the seconds.)
I certify that the times shown above were properly recorded by competent timekeepers/phototimers.
Chief Timekeeper: Name Signature
Wind AssistanceLAPSCORER’Ssheet must be
Wind Gauge Readingattachedfor distances 3km and over
I certify that in my estimation wind assistance did not exceed two (2) metres per second.
Wind Gauge Operator:
Implement Specifications / Shot / Discus / Javelin / Hammer / WeightActual Weight
I certify that the implement used by the competitor was weighted as above, and comply with WMA/IAAF/AMA specifications.
Equipment Officer: Name Signature
Race Walk Chief Judge
I certify that the athlete competed as per the IAAF definition of Race Walking and was not disqualified.
Chief Walk Judge:Name Signature
Meet Manager's Certificate
I certify that the track, circles, field markings, etc, comply with WMA/IAAF specifications, and that the meet was conducted under WMA/IAAF rules.
Meet Manager:Name Signature
Send this form direct to your State Statistician. Their names and addresses are on the back of this form.
State Statistician’s Certificate
I certify that the above details are correct, and that the competition was conducted in accordance with the rules of the World Masters Athletics with whom AMAI is affiliated.
State Statistician:Name Signature
Instructions:
Please obtain copies of all relevant slips used at the meeting, such as print-outs of timing, field games officials' sheets, lap scoring sheets, etc. This form is to be used for both State and Australian record applications. World record applications are made on a different form.
Send this form to the State Statistician, who will send it on to the Australian Records Officer (Clyde Riddoch) if it is also an Australian or World record. Details of the current State Statisticians are:
A.C.T.Canberra:Philip White
10 Baratta Street
CRACE ACT 2911
Email:
Mobile: 0400 711 024
New South Wales:Peter Murray
18 Rye Avenue
BEXLEY NSW 2207
Email:
Queensland:Heather Doherty
14 Rennie Street
INDOOROOPILLY QLD 4068
Email:
Phone: (07) 3870 1736
South Australia:Ros Lowe
2 Osterley Avenue
BRIDGEWATER SA 5155
Email:
Phone: (08) 8339 2274
Tasmania:Geoffrey Gibbons
GPO 2148
HOBART TAS 7001
Email:
Mobile: 0418 999 165
Victoria:Clyde Riddoch
14 Joan Street
SUNSHINE WEST VIC 3020
Email:
Phone: (03) 9859 9855 or 9363 2515 (H)
Mobile: 0439 902 907
Western Australia: Barbara Blurton
6 Curran Court
KALAMUNDA WA 6076
Email: