ULSTER MASTERS ENTRY FORM
PLEASE COMPLETE THE ENTRY FORM BELOW AND ENTER THE SUBMITTED/ESTIMATED TIME FOR EACH INDIVIDUAL
SWIMMER IN THE BOX BELOW THE EVENT NUMBER
EACH SWIMMER MUST HAVE A SWIM IRELAND REGISTRATION NUMBER
Name
Club
Event
1
100 IM
Event
2
200FS
Event
3
100Brs
Event
4
50Back
Event
5
100 Fly
Event
6
50 FS
Event
7
200 Brs
Event
8
100 Back
Event
9
25 FS
Event
10
25 Back
SI Reg No
Event
12
25 Brs
Event
13
200 Fly
Event
14
400 FS
Event
15
25 Fly
Event
16
200 Back
Event
17
50 Brs
Event 18
100 FS
Event
19
50 Fly
Event 20
Relay
See over
Event 21
Relay
See over
Club
Event
1
100 IM
Event
2
200FS
Event
3
100Brs
Event
4
50Back
Event
5
100 Fly
Event
6
50 FS
Event
7
200 Brs
Event
8
100 Back
Event
9
25 FS
Event
10
25 Back
SI Reg No
Event
12
25 Brs
Event
13
200 Fly
Event
14
400 FS
Event
15
25 Fly
Event
16
200 Back
Event
17
50 Brs
Event 18
100 FS
Event
19
50 Fly
Event 20
Relay
See over
Event 21
Relay
See over
Club
Event
1
100 IM
Event
2
200FS
Event
3
100Brs
Event
4
50Back
Event
5
100 Fly
Event
6
50 FS
Event
7
200 Brs
Event
8
100 Back
Event
9
25 FS
Event
10
25 Back
Event
12
25 Brs
Event
13
200 Fly
Event
14
400 FS
Event
15
25 Fly
Event
16
200 Back
Event
17
50 Brs
Event 18
100 FS
Event
19
50 Fly
Event 20
Relay
See over
Event 21
Relay
See over
Male / Female :
Address
Event 11
Relay
See over
Date of Birth
Contact Telephone No
Name
Male / Female :
Address
Event 11
Relay
See over
Date of Birth
Contact Telephone No
Name
Male / Female :
Address
Date of Birth
SI Reg No
Contact Telephone No
Event 11
Relay
See over
THE 1500 FREE DISTANCE EVENT FOR MASTERS SWIMMERS WILL TAKE PLACE DURING
THE IRISH SC CHAMPIONSHIPS AT LISBURN
ON SATURDAY 13TH DECEMBER 2014
ENTRIES FOR THIS EVENT CAN ONLY BE ACCEPTED IN PAPER FORMAT
Name
Club
Male / Female :
dress
Date of Birth
SI Reg No
Contact Telephone No
Event
22
1500FS
ULSTER MASTERS RELAY & SUMMARY ENTRY FORM
RELAY
EVENT
NO.
TEAM NAME
RELAY SWIMMERS NAMES
SI Reg
no.
M/F
FEE PER
EVENT
£10.00
TOTAL £
NAME
ADDRESS
PHONE NO
CLUB
ENTRIES WILL NOT BE ACCEPTED WITHOUT A SWIM IRELAND REGISTRATION NUMBER FOR EVERY SWIMMER TAKING
PART.
TOTAL INDIVIDUAL ENTRIES
@ £3.50 PER EVENT
RELAY ENTRIES
@ £3.50 PER EVENT
TOTAL ENCLOSED
Cheques should be made payable to Swim Ulster Ltd and sent to :
Swim Ulster, Aurora Aquatic & Leisure Complex, 3 Valentine Road, Bangor, Co Down, BT20 4TH