APPLICATION FOR RECOGNITION OF ROAD-RACE PERFORMANCES
USA TRACK & FIELD 
(Revised 8/7/05)

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: 
6. Address:


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 30% 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

A. TIMING SYSTEM	
1.Type and make of primary timing system: 	
(Note that Chip NET times are not official but Chip GUN times are acceptable.)

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 (exceptabove times include decimals):
     	
			
F. MULTIPLE	STARTS	
1. If more than one start, give times and 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.  If finishers were not timed individually and interpolations used, indicate the range of times determined by 
interpolation:
6.  Chief Scorer or Race Director: 
     
IV. BONA FIDE COMPETITION
Name of Referee or Race Director testifying that the race was conducted according to the rules, standards,and 
requirements of USATF (rules 242-245 and 144 at usatf.org/about/rules/2005):