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NHS Member Service Hours
Please use this form to submit community service hours for NHS.
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* Indicates required question
Name (Last, First)
*
Your answer
Name/Title of Service Activity
*
Your answer
Date of Event
*
MM
/
DD
/
YYYY
Number of Hours Spent on Activity
*
Your answer
Activity Leader's Name
*
Your answer
Activity Leader Phone Number or Email Address
*
Your answer
What was your role at this event? What did you do? Provide details.
*
Your answer
Any additional comments or clarifications for this event.
Your answer
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