RECORD CLAIM FORM

It is the responsibility of swimmers/clubs to claim records

1

Stroke( Freestyle, Backstroke, Butterfly, Breaststroke, Ind, Medley or relay type)

 

2

Length of Event

 

3

Length of course ( 25m or 50m)

 

4

Type of Record (Jun or Sen)

 

5

Time Achieved

 

6

Swimmers Name

 

7

Swimmers date of birth

 

8

Swim Ireland membership no.

 

9

Club Name

 

10

Relay Team Names in competing order ( If Jun include date of birth of each swimmer)

1

2

3

4

11

Name of Competition

 

12

Competition Organising Body

 

13

Venue of Competition (Full name and Address)

 

14

Date of race

 

15

Timing System used

 

16

Owners of Timing System

 

17

Have you included Official Results

 

18

Name of person submitting application

 

19

I conform that the information on this form is accurate

Signature of above person

 

20

Position within club

 

21

Date of Application

 
 

For Hon. Recorder Use Only

 

22

Received On

 

23

Official Results Received ( Y/N )

 

24

Approved On

 

25

Submitted to Connacht Region

 

26

Hon Recorder Signature

 

The form (s) should be posted (not faxed) to:

Connacht Recorder Ms. Patricia Cleary, Cornamagh, Athlone, Co Westmeath. Phone: 090-6475425