Ulster Individual Record Claim Form

Ulster 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.

Only one claim form per Ulster Record can be submitted
Name of Swimmer:*

First NameLast Name
Date of Birth:*

DayMonthYear
Home Address:*

Address Line 1

Address Line 2

AddressCounty

Postal / Zip CodeCountry
E-mail Address:*
Mobile Number:*

MobileMobile
Swim Ireland Club:
Event Details
Please confirm which level this record relates to:*

Ulster Junior RecordUlster Senior Record
Stroke:*

FreestyleBackstrokeBreaststrokeButterflyIndividual Medley
Event:*

50m Freestyle100m Freestyle200m Freestyle400m Freestyle800m Freestyle1500m Freestyle50m Backstroke100m Backstroke200m Backstroke50m Breaststroke100m Breastroke200m Breaststroke50m Butterfly100m Butterfly200m Butterfly200m Individual Medley400m Individual Medley
Pool Format:*

Short Course (25m)Long Course (50m)
Time Achieved:*
Name of Competition where Record was achieved:*
Venue of Competition:*
Date of Ulster Record Performance*

DayMonthYear
Website link to where 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:

Ulster Record Claim Form