| Program Name: | ||
| .________________________________________ | ____________ | ______________ |
| Club Name: | District: | # of members in club |
| ________________________________________ | ____________ | ______________ |
| Completed by:. | Phone: | |
| ________________________________________ | ____________ | ______________ |
| Program/Project | Hours | # Members Participating | Dollars In Kind Donations-do not report money raised here |
| . | . | . | . |
| . | . | . | . |
| . | . | . | . |
| . | . | . | . |
| . | . | . | . |
| Total Number of Projects | Total Hours | Total Members | Total Dollars |
Refer to the club manual for information on programs. Reporting period is January 1 to December 31..