LLUBMC-Community Events Form 2019

Date of Event

Duration of Event (# of hours)

Name of Program, Event, Activity or Service

Location of Event

Description of Event

If no, who hosted the event?

Number of individuals served

Overall cost or value of service or items donated (optional)

Include the dollar amount in the field

Community Contact Phone Number

Community Contact Email

#1 Employee's Position/Credential

#1 Employee's Hours Spent (including preparation as well)

#2 Employee's Position/Credential

#2 Employee's Hours Spent (including preparation as well)

#3 Employee's Position/Credential

#3 Employee's Hours Spent (including preparation as well)

#4 Employee's Position/Credential

#4 Employee's Hours Spent (including preparation as well)

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