APPLICATION FOR RECOGNITION OF ROAD-RACE PERFORMANCES FOR NC STATE RECORDS
USA TRACK & FIELD 
(Revised 10/16/14)

IMPORTANT NOTE: Select times on runners should be taken throughout the race by at least one secondary timer.
Also, in addition it is recommended that the record setter be individually timed by at least two running watches.

I.  GENERAL INFORMATION

A. RACE		
1. Name
2. Distance:  
3. USATF course measurement certificate number: 
4. Date:   
5. Date next year:  
6. Location:  
7. Last year's race name: 
8. First year: 

B. PERSONNEL
1. Your name and tel: 
2. Your email:
3. Director's name and tel:                 	
4. Email: 
5. Web site: 

C. PARTICIPANTS
1. Entrants:
2. Male finishers:
3. Female finishers:

D. RACE CONDITIONS
1. Humidity, wind, temperature, rainfall, man-made obstructions, etc, which might have affected performances: 

II.  THE COURSE

A. CERTIFICATION	
1. Race Director attesting that the race was run as described in the course certification: 

B. RECORD REQUIREMENTS              
1. Is the start to finish drop one meter or less per km? (Yes/ No):  
2. Is the start to finish separation 50% or less of the race distance? (Yes/ No):				  

C. RECORD EVIDENCE                 		
1.  Place a "x" against any of the following available:
     Start photograph...
     Turn-around photograph.....
     Finish photograph.....
     Photograph or other data indicating wind direction.....
     Record of race numbers at appropriate points.....
      Video tape (described below).....


III. TIMING AND SCORING

(Note that Chip NET times are not official.Required format:
00hr:00min:00.00sec)

A. TIMING SYSTEM	
1.Type and make of primary timing system: 	

B. WINNING MAN'S TIME		  
1. Primary (name of timer): 
2. Watch 1 (name of timer): 
3. Watch 2 (name of timer): 
4. Watch 3 (name of timer):

C. WINNING WOMEN'S TIME	 		
1. Primary (name of timer): 
2. Watch 1 (name of timer):
3. Watch 2 (name of timer):
4. Watch 3 (name of timer):

D. NOTABLE  NON-WINNING TIME		
1. Name: 
2. Age (dob):
3. Primary (name of timer): 
4. Watch 1 (name of timer):
5. Watch 2 (name of timer):
6. Watch 3 (name of timer):

E. CERTIFICATION OF TIMES	
1. Chief Timer certifing timing was done in accordance with USATF Rule 165 (except above times include decimals):
     	
			
F. MULTIPLE STARTS	
1. If more than one start, give times and participant categories:  
2. If more than one location, explain procedure to ensure time accuracy:


     
G. SELECT TIMING AND SCORING 	
1.  Was select timing used to ensure that times and runners were properly matched? (Yes/No): 
2.  Number of timing gates into which the finish line was divided:
3.  Number of primary timers used: 
4.  If more than one primary timer was used, describe how they were synchronised and how the times from one
 gate are reconciled with the others: 
5.  Chief Scorer or Race Director: 
     
IV. BONA FIDE COMPETITION
(Unlike for national records, sanctioning not required for NC records.)
Name of Referee or Race Director testifying that the race was and conducted according to the rules, standards, and 
requirements of USATF (rules 262, 242-245 and 144 at usatf.org/about/rules/):