Record Application for Race Directors

GEORGIA (only) Road Race Record Application Form
Part I:  General Information
Race:  Name________________________________
Distance______________________km/miles  Date____/___/20___
Location:  City______________________________  State_____________
Last year's race name____________________1st year held____________
Personnel:  Your name___________________________________________
Email (or Telephone)_____________________________________________
Director's name_________________________________________________
Race Office Telephone___________________________________________
Web site_______________________________________________________
Numbers:  Male Entrants_________________Female Entrants__________
Part II:  The Course
***I, the undersigned, hereby attest that the race identified in Part I above was
run on the course as described on the USATF Course Measurement Certificate
# ______________________________.
In the event that a record needs to be validated, the following evidence is available
______photograph of start            ______photograph of finish
______photograph of turnaround  ______video tape of____________
______recording of race numbers at appropriate points
______photograph or other data indicating wind direction
***Signed _______________________________________________Race Director
Part III:  Timing and Scoring
Timing System
Type/make of primary timing system______________________________________
(Note that Chip NET times are not official but Chip GUN times are acceptable;
however, both must be submitted.)
Winning times
Time of men's winner __________________  Signature of timer_________________
Time of women's winner________________  Signature of timer_________________
The times recorded above are accurate:
***Signed _____________________________________________Chief Timer
Non-winning times for other individuals in case of record or notable performances:
Name of athlete_______________________Age___Date of birth__________Time_________
Name of athlete_______________________Age___Date of birth__________Time_________
Name of athlete_______________________Age___Date of birth__________Time_________
(Citizenship if applicable)
Multiple loops    
Did the course consist of multiple loops on the road?  ___yes ___no
If yes, indicate the length of a single loop _____________km/miles
Copies of lap sheets must be submitted for individuals suspected of record or notable
Part IV:  Bona Fide Competition
I, the undersigned, being the duly appointed referee for the above described race, hereby attest that
    a.  the start was fair;
*** b.  the course was monitored to prevent COURSE CUTTING and to the best of my knowledge all
            official finishers ran the course AS CERTIFIED;
*** c.  the standards of bona fide competition were in effect and that all award winners competed
            fairly WITHOUT ASSISTANCE.
***Signed__________________________________________Race Director (or Referee)
Part V:  Results
The complete results with ages and hometowns have been emailed to
AND a hard copy mailed to Joyce Hodges-Hite, P.O. Box 717, Millen, Ga. 30442.