NATIONAL RECORD APPLICATION FORM

 

 

1.      Stroke (Freestyle, backstroke, breaststroke, butterfly, individual medley) _________

2.      Length of event ___________              Length of course ______________

3.      Name of swimmer  __________________________________________         

4.      Swimmer's Date of Birth _____________                  Age Group________

5.      Name of club ______________________________________________          

6.      Date of race ______________________

7.      Time achieved ____________________      

8.      Name of competition ________________________________________

9.      City at which race took place and name of pool ____________________

10. Was the course measured by a qualified person? Print name.

_______________________________________________

11. In my opinion, all FINA Rules have been met.

            _______________________                                _____________

Print Name of Competition Referee                                  Signature of Referee      

12. Application submitted by:          

Submit this form to ASATT 1^st Vice President within 30 days of the performance.

Attach a copy of the Official Meet Results