Veterans Hospitals - created by phpFormGenerator

Veterans Hospitals Report

Veterans Hospitals Report "Volunteer Hours, Mileage and Contributions Report".

Date of Report: * Please use the calendar provided to enter the date of the report.
Lodge: * Please select your Lodge.
Lodge Committee Chairperson: * Please enter the first and last name (in that order) of your Lodge's Chairperson.
Lodge Committee Chairperson E-mail Address: * Please enter the e-mail address where you would like your copy of this report sent. This can be your Lodges or your personal email address.

Number of Activities: *

Please enter the number of activities held by your Lodge.

Number of Elks: *

Please enter the number of Elks envolved with the event.

Number of Elk Hours: *

Please enter the number hours volunteered by Elks.

Number of Elk Miles Traveled: *

Please enter the total mile traveled by Elks.

Total Monies Contributed: *

Please enter the amount of monies your Lodge and Members have contributed. This should include both Elks and Non-Elks. $

Number of Successful Activities: *

Please enter the number of successful activities held by your Lodge.

Number of Non-Elks: *

Please enter the number of Non-Elks envolved with the event.

Number of Non-Elk Hours: *

Please enter the number hours volunteered by Non-Elks.

Number of Non-Elk Miles Traveled: *

Please enter the total mile traveled by Non-Elks.

Value of Items Contributed: *

Please enter the number of items your Lodge and Members have contributed. This should include ctributions by both Elks and Non-Elks. $

Comments: * Please type in your comments - be specific. Tell us about any special activities your Lodge held to raise public awareness to your area of responsibility.

Type the following: For security purposes, please type the letters in the image.