PAC Event Demographics Information

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Please complete this form for each event/activity that committee does for the month.

Committee Name *

Choose from the list.

Date of Event *

Please type mm/dd/yyyy format

Event/Activity *

Give the name of the event

Location *

Location of the Event

Number of Chapter Participants *

Please enter the number of chapter members in attendance

Number of Participants Excluding Chapter Members *

Number of Participants excluding Chapter Members

Event Summary *

Purpose of Event and Event Highlights -If your committee was not listed please type it in.

Five Point Thrust *

Please select 5- point thrust this activity falls under

Report Submitted By *

Please enter your name

Submit

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