Buy IPA World & State Record Certificate

ONLINE PAYPAL WORLD RECORD CERTIFICATE
Certificate $27.00 / Framed Certificate $50.00 (includes Shipping)

: : This form must be filled out completely in order to expedite the individuals certificate : :

Certificate

Competitor's Name

Street Address

City, State, Zip

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Phone E-mail Address

Age Birth date

IPA Membership Expiration Date

Meet Record Set at

Date Record Set

Enter Record Weight for Event (leave blank if not a record)

Squat	Deadlift
Bench	Total

Weight Class Sex

Division Subdivision

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