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:
Stroke:
Event:
Pool Format:
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