RECORD CLAIM FORM

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