Evidence Submission Form - The Book of World Records

Evidence Submission Form – The Book of World Records

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Name

First

Last

Phone

Date of Birth

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Record Application Number / Reference ID

Proposed Record Title

Date of Record Attempt

Venue / Location of Attempt

Photographs (Please Upload)

Click or drag files to this area to upload. You can upload up to 8 files.

Videos Upload

Click or drag files to this area to upload. You can upload up to 2 files.

Supporting Documents

Click or drag files to this area to upload. You can upload up to 10 files.

Items Supporting Attempt

Media Coverage Link 1

Media Coverage Link 2

Media Coverage Link 3

Checkbox Items

I confirm that the evidence submitted here is authentic, unedited, and accurately represents the record attempt.

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