Team Applicant S Details (In Order That They Swam) s1

/ Swimming Record Application Form
(Individual & Team Events) / Form Reference R7.1.1 (SW)

Individual Applicant’s Details

Forename / Surname
SASA Registration No. / Club
Date of Birth / D / D / M / M / Y / Y

Team Applicant’s Details (in order that they swam)

Club
Forename / Surname / SASA
Registration No.
Forename / Surname / SASA
Registration No.
Forename / Surname / SASA
Registration No.
Forename / Surname / SASA
Registration No.

Details of Record Applied For (mark with an X for all that apply)

Male / Female / Mixed / Senior / Junior / 11 yrs / 12 yrs / 13 yrs / 14 yrs / 15 yrs / 16 yrs / 17 yrs / 18 yrs
Additional Details for Club Records
(mark with an X for all that apply) / Club Team Record / National Team Record
Meet / Date / D / D / M / M / Y / Y
Venue / Pool Length / metres / Licence No.

Please Insert Time of Record in Appropriate Box(s)

Individual / 50m / 100m / 200m / 400m / 800m / 1500m
Freestyle
Backstroke
Breaststroke
Butterfly
Individual Medley
Team / 4 x 50m / 4 x 100m / 4 x 200m
Freestyle
Medley

Record Application Made by

Initials & Surname / Position Held
Email Address / Contact Tel No.
Please tick if you require a certificate / (Certificates will be posted to individuals unless otherwise requested, 1 certificate will be produced for Club records, extra certificates can be produced on request )

Office Use Only

Application received by office: / Date / Initials
Application verified against official results: / Date / Initials
Record annotated (awaiting ratification) on the computer: / Date / Initials
Record annotated (awaiting ratification) on the website: / Date / Initials
Statistics record updated: / Date / Initials
Record ratified by Swimming Committee: / Date / Initials
Certificate Requested? Issued to applicant: / Date / Initials

This form must be completed within 30 days of the competition and must be accompanied by a copy of the official results.

Please note that forms which are incomplete or forwarded without supporting documentation will be returned.

Swimming Record Application Form Page 1 of 1 March 2015