Gold Annual Survey Form (#6)

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council total

Assembly Total

Date / Time

First Name

Last Name

Annual Survey Mobile Frendly #35

Identification
Council Survey
Assembly Survey

ANNUAL SURVEY
OF FRATERNAL ACTIVITY

Please complete the following before the next step.

Survey Year

Current Year

Survey Date

First Name

Last Name

Do you wish to file a survey for the Assembly?

Yes

INDIVIDUAL MEMBER WORKSHEET 1728A

Council Part 1

Faith Activities

Council Faith Activities

Activity Letter	Activity Hours

Total Council Faith

Family Activities

Council Family Activities

Activity Letter	Activity Hours

Total Council Family

Community Activities

Council Community Activities

Activity Letter	Activity Hours

Total Council Community

Life Activities

Council Life Activities

Activity Letter	Activity Hours

Total Council Life

Other Activities

Council Other Activities

Activity Letter	Activity Hours

Total Council Other

Total Council Activity Hours:

Council Total

INDIVIDUAL MEMBER WORKSHEET 1728A

Assembly Part 2

Complete this section only if you are a 4th Degree Member, Thank you.

Assembly Hours

Faith Activities

Assembly Faith Activities

Activity Letter	Activity Hours

Total Assembly Faith

Family Activities

Assembly Family Activities

Activity Letter	Activity Hours

Total Assembly Family

Community Activities

Assembly Community Activities

Activity Letter	Activity Hours

Total Assembly Community

Life Activities

Assembly Life Activities

Activity Letter	Activity Hours

Total Assembly Life

Other Activities

Assembly Other Activities

Activity Letter	Activity Hours

Total Assembly Other

Total Assembly Activity Hours:

Assembly Total

ANNUAL SURVEYOF FRATERNAL ACTIVITY

Please complete the following before the next step.

INDIVIDUAL MEMBER WORKSHEET 1728A

Council Part 1

Faith Activities

Family Activities

Community Activities

Life Activities

Other Activities

Total Council Activity Hours:

INDIVIDUAL MEMBER WORKSHEET 1728A

Assembly Part 2

Assembly Hours

Faith Activities

Family Activities

Community Activities

Life Activities

Other Activities

Total Assembly Activity Hours:

ANNUAL SURVEY
OF FRATERNAL ACTIVITY