Complete Name *

Mobile No. *

Date of Birth *

Gender *
MaleFemaleOther

E-mail *

Occupation *

Permanent Address *

Detailed description of your attempt (3000 characters limit) *

I agree to the following terms and conditions in relation to my record

1) I authorize, World Records Union to use the material sent in their publications,
productions, licensed merchandise, websites or any other media as television, radio etc., in
any manner and for any purpose. I have no claim on them. Under any condition, World Records union
will be under no obligation to return any of these materials.

2) I accept that I do not want World Records Union to identify me as the author or creator
of any of the materials that I am sending in connection with my record attempts.

3) I accept ‘World Records Union’ will not accept any responsibility for the safety of
participants. It is the sole responsibility of the claimant, to get insured and to ensure that all
the necessary safety measures and guards are taken in consideration. All the equipments
and gadgets used are to be thoroughly checked, prior to the record attempt. It has to further
ensure that all required relevant compliance with any Government or non-Government
authority along with local health and safety measures applicable at the time of the
performance are in place.

4) I acknowledge that the information given here are true to the best of my knowledge.

I agree * Yes