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.
Event Details
Please confirm which level this record relates to :*

Ulster Senior RecordUlster Junior Record
Stroke / Event :*

50m Freestyle100m Freestyle200m Freestyle400m Freestyle800m Freestyle1500m Freestyle50m Backstroke100m Backstroke200m Backstroke50m Butterfly100m Butterfly200m Butterfly50m Breaststroke100m Breaststroke200m Breaststroke100m Individual Medley200m Individual Medley400m 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 :*

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