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 Name Last Name
Date of Birth: *

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Home Address: *

E-mail Address: *
Mobile Number: *

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

Ulster Junior Record Ulster Senior Record
Stroke: *

Freestyle Backstroke Breaststroke Butterfly Individual Medley
Event: *

50m Freestyle 100m Freestyle 200m Freestyle 400m Freestyle 800m Freestyle 1500m Freestyle 50m Backstroke 100m Backstroke 200m Backstroke 50m Breaststroke 100m Breastroke 200m Breaststroke 50m Butterfly 100m Butterfly 200m Butterfly 200m Individual Medley 400m 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 *

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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