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Text Box: Work Assessment Validation Form

___________________________
                                                                                                                                              (Member Number)

                 Member                      _______________________________________________________________
                                                                                                      (Signature)

                 Member Address         _______________________________________________________________

                 Project                        _______________________________________________________________

                 Project Coordinator     ____________________________________________________/___________
                                                                                                      (Signature)                                                                                           (Date)

                 After a project is completed, fill in this form, sign it and have the coordinator validate with his/her signature and date. Return before October 1 for proper current year Work Assessment credit. Bring to a monthly meeting and place in the box provided, near the membership table, or mail to the Club’s P.O. Box. If this form is not retuned on time, credit will not be included in membership dues renewal calculations.

Text Box: Work Assessment Validation Form ___________________________ (Member Number) Member _______________________________________________________________ (Signature) Member Address _______________________________________________________________ Project _______________________________________________________________ Project Coordinator ____________________________________________________/___________ (Signature) (Date) After a project is completed, fill in this form, sign it and have the coordinator validate with his/her signature and date. Return before October 1 for proper current year Work Assessment credit. Bring to a monthly meeting and place in the box provided, near the membership table, or mail to the Club’s P.O. Box. If this form is not retuned on time, credit will not be included in membership dues renewal calculations.