Therapy Trustees Visitation Report

Trustee's name

Trustee's email address

Date of visit

District

Lodge visited

Lodge representatives present

Is the lodge following the guidelines for:

Submission of Donations
YesNo

Coin Box Events
YesNo

Tall Elks
YesNo

Bequeaths
YesNo

Living Tribute Memorials
YesNo

Honor Gifts
YesNo

Is information on the Therapy program included in the lodge bulletin?
YesNo

Is the lodge planning a therapy demonstration?
YesNo

Is the lodge planning a special fundraising event or coin box dinner?
YesNo

What was discussed during the visitation:

Mileage (round trip)?

Time at lodge for visitation (in minutes)?

Round-trip travel time (in minutes)?