SOCIETY ________________________________________________________________________
PROGRAM CHAIRMAN ____________________________________________________________
Please return this completed form, including Program Report on reverse side to:
| (Attach additional sheet of paper if necessary)   |
Cheri George CFMS Program Aids 5006 N. Bentree Circle Long Beach, CA 90807-1009 |
SOCIETY___________________________________________________________________________________
PERSON REPORTING ________________________________________________________________
TITLE _____________________________________________________________________________
ADDRESS ________________________________________________________ PHONE __________
CITY, STATE, AND ZIP _______________________________________________________________
| MONTH | PROGRAM (Include name and tilte, if any, of presenter, address and phone number if possible, and description of program.) |
NUMBER ATTENDING |
HOW RECEIVED |
|---|---|---|---|
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