Ulster Relay Record Claim Form
Relay Events Only - it is the responsibility of the Club Coach to claim all Ulster Records achieved in a Club, Regional, National or Overseas Competition
Name of Swim Ulster Club :
*
Name of Swimmer 1 :
*
First Name
Last Name
Date of Birth for Swimmer 1 :
*
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Day
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Month
Year
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Name of Swimmer 2 :
*
First Name
Last Name
Date of Birth for Swimmer 2 :
*
-
Day
-
Month
Year
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Name of Swimmer 3 :
*
First Name
Last Name
Date of Birth for Swimmer 3 :
*
-
Day
-
Month
Year
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Name of Swimmer 4 :
*
First Name
Last Name
Date of Birth for Swimmer 4 :
*
-
Day
-
Month
Year
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Please give the name & address where the Ulster Record Certificates should be sent to :
*
Name
Street Address Line 1
Town / City
County
Postcode
Email Address of Coach submitting this Relay Record Claim :
*
example@example.com
Mobile Phone Number :
*
Please enter a valid phone number.
Event Details
Please confirm which level this record relates to :
*
Ulster Senior Record
Ulster Junior Record
Stroke / Event :
*
4 x 50m Freestyle Team Relay
4 x 50m Medley Team Relay
4 x 100m Freestyle Team Relay
4 x 100m Medley Team Relay
4 x 200m Freestyle Team Relay
Gender of Relay :
*
Female
Male
Mixed
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 :
*
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Month
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Day
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: