Application for CT Swimming Record for LSCs

This Connecticut Record Application is for non-CT athletes and relay teams applying for a Connecticut Record.
Today's Date:* [Calendar]
Name of Submitter:*

If this is for an individual record, please fill out the athlete's name below. If this is for a relay record, please fill out 4 names later in this application.
Athlete Name:
Club athlete is registered with:

Meet Name:*
First day of meet date:* [Calendar]
Location of Meet:

Race Course:* SCY LCM
Stroke:* Freestyle Backstroke Breaststroke Butterfly IM Free Relay Medley Relay
Distance:* 50 100 200 400 500 800 1000 1500 1650
Swim Type:* Final Prelim Swim-off Split Relay

For relay record applications, team members must be listed in order of swimming. Please include age. Example: Jon Smith, 14
Relay Swimmer Name #1:
Relay Swimmer Name #2:
Relay Swimmer Name #3:
Relay Swimmer Name #4:

Please contact with any questions or comments.
  (What is this for?)