Chapter Name:
Type of Effort:
Date of Effort:

If Meeting/Program:
Theme of the event:
Cost per ticket:
Number of Attendees:
Name of Speaker(s):

Please fax, email or mail a sample of your flyer or meeting program.

 If mailing/membership promotion:
Number of persons chapter attempted to reach:
Number of persons reached (ie. new members, etc):
Please fax, email, or mail a sample of your promotion (if applicable)

 Other type of effort:
Describe the effort:
Perceived effectiveness/evidence of effectiveness of the effort:

Please fax, email or mail a sample of your effort (if applicable).