Ulster Individual Record Claim Form

Ulster Individual Record Claim Form

Individual Events Only - it is the responsibility of the Swimmer to claim all Ulster Records achieved in a Club, Regional, National or Overseas Competition
Name of Swimmer :*

First NameLast Name
Date of Birth :*

DayMonthYear
Club Name :*
Home Address :*

Street Address

Street Address Line 2

Town / CityCounty

Postcode
Email Address :*
example@example.com
Mobile Phone Number :*
Please enter a valid phone number.Format: (000) 000-0000.
Event Details
Ulster Senior RecordUlster Junior Record
50m Freestyle100m Freestyle200m Freestyle400m Freestyle800m Freestyle1500m Freestyle50m Backstroke100m Backstroke200m Backstroke50m Butterfly100m Butterfly200m Butterfly50m Breaststroke100m Breaststroke200m Breaststroke100m Individual Medley200m Individual Medley400m Individual Medley
25m Format (Short Course)50m Format (Long Course)
Time Achieved :*
Name of Competition where Record was achieved :*
Venue of Competition where Record was achieved :*
Date when Record was achieved :*

DayMonthYear
Date
Website link to where the Official results can be found to verify this record :*
To submit your Ulster Record Claim Form please click the Submit button below.
Should be Empty:

Event Details