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 Name
Last Name
Date of Birth :
*
-
Day
-
Month
Year
Date Picker Icon
Club Name :
*
Home Address :
*
Street Address
Street Address Line 2
Town / City
County
Postcode
Email Address :
*
example@example.com
Mobile Phone Number :
*
Please enter a valid phone number.
Format: (000) 000-0000.
Event Details
Please confirm which level this record relates to :
*
Ulster Senior Record
Ulster Junior Record
Stroke / Event :
*
50m Freestyle
100m Freestyle
200m Freestyle
400m Freestyle
800m Freestyle
1500m Freestyle
50m Backstroke
100m Backstroke
200m Backstroke
50m Butterfly
100m Butterfly
200m Butterfly
50m Breaststroke
100m Breaststroke
200m Breaststroke
100m Individual Medley
200m Individual Medley
400m Individual Medley
Pool Format :
*
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 :
*
-
Day
-
Month
Year
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.
Submit
Should be Empty: