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LINCOLNSHIRE
COUNTY AMATEUR SWIMMING ASSOCIATION |
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Affiliated to
ASA East Midland Region |
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AGE GROUP RECORD
CLAIM FORM |
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Full name: |
Club: |
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Address: |
Date of swim: ..….../.….../.......... |
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Date of birth: ..….../.….../.......... |
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Age on day of swim: .............. |
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Post code: |
Stroke (please circle one): FC Bk Br By IM |
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Sex (please circle one): Male female |
Distance (please circle one): 50 100 200 400 800 1500 |
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Venue: |
Pool length: ……m / yds |
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Competition (under ASA/FINA laws): |
Actual time: .….….m……….………..s |
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Converted time (if not swum in 25m pool): …….m…..….……...s |
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Signature of swimmer: |
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CLUB OFFICER'S DETAILS |
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Signed: |
Club records Officer / Hon Secretary / Club Officer |
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Tel No: |
Date: ..….../..….../.......... |
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email address (to confirm receipt of claim): ...................................................@........................................... |
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Notes:
1. Each claim (accompanied by evidence) must be with the County Records Officer
within 28 days if the swim.
2. A full list of conditions is available from the County Records Officer and
on the County website.
3. The County Records Officer is Mel Crowley, 21 Little Bargate St, Lincoln
LN58JL email: patrick.melinda@ntlworld.com 01522 889983