1. Title of Event:     2. Date of Event:

3. Social Action Chairman:  

4. Hours (From - To):

5. Location of Event (City, State)

6. Sponsoring Chapter:     

7. Chapter Location (College):

8. Was this activity a national and/or regional Social Action Program? Yes No

9. How many brothers were present?

10. Approximately how many people were serviced?  

11. Description of Activity:

12. Approximate Number of Attendees:     13. Number of Brothers Present:

15. Type of Media Coverage (if any): Newspaper    Radio    TV    Internet    Other (If Other, Specify)

16. Pictures Taken of Event: Yes No     17. Video Taken of Event: Yes No

18. Rate the Event's Success: Poor Fair Good Excellent

19. Place Additional Comments Here:

21. Contact Information For Additional Questions

Name:      

Phone:      

Email: