Documentation of Qualifying Total for the
2008 IWF-Masters World Weightlifting Championship

Fill out this form completely and send to:

USAW Masters
130 Brandywine Rd
Savannah, GA 31405

Athlete Name  _______________________________________

Club          _______________________________________

USAW Reg #    _______________________________________

Phone ______________________  Work __________________

Address       _______________________________________

City/State    _______________________________________

Competition Site 
(city/state)  _______________________________________

Sanction #    _______________________________________

Date of Competition _________________________________


Note: Must take place between 8/25/2007 and 4/6/2008  


Two lift total __________________

Date of Birth  __________________

Bodyweight Class ______________  Bodyweight ___________

Age Group      __________________


We, the undersigned referees and weigher are sure that the weights and scales
have been certified and have judged the correct performance of the above 
total and have checked the weight of the lifter as required by the rules of
the USAW Masters Committee.

PRINT and SIGN

Referee _____________________________________________

Referee _____________________________________________

Referee _____________________________________________

Weigher _____________________________________________

Signature of Athlete ________________________________

NOTE: At least two of the officials must be National Referees