WNPF Record Certificate Order Form
Please allow 6 weeks delivery
LIFTER’S NAME _____________________________ TODAY’S DATE____ ____ ____
ADDRESS ______________________________________________________
TEL. # _______ _________________________ EMAIL _______________________
Please fill out
the following Date of event ___
___ ___
Which lift ________________ (bench, curl, etc.) How much weight lifted ________
Your weight class _________ Your division _________________
Type of record ________________ meaning American, State, National, World
Certificate
# 2 Date of event ___ ___ ___
Which lift ________________ (bench, curl, etc.) How much weight lifted ________
Your weight class _________ Your division _________________
Type of record ________________ meaning American, State, National, World
Certificate # 3 Date of event ___ ___ ___
Which lift ________________ (bench, curl, etc.) How much weight lifted ________
Your weight class _________ Your division _________________
Type of record
________________ meaning American, State, National, World
Please send to: WNPF,
Cost: Basic certificate-$10 Basic Certificate with folder-$15,
Certificate with black marble plaque & glass
top-(BOARD IS 12 x15)-$35
Red or black Piano Finish Plaque with color
certificate & glass top (BOARD IS 12x15)-$50