Charitable Data Reporting Form 2021-22 (North)
All State Officers, Chairpersons, & District Chairpersons to fill out this form. Fields marked with an asterisk (*) are required fields.
Date of Event
The event should be within the current elk year.
Your Home Lodge
Select Your Home Lodge
Bullhead City #2408
Chino Valley #2842
Show Low #2090
Select your home Lodge from this dropdown menu.
Grand Lodge Committeeman
Laws & Resolution Committee
Past Presidents Association
Please check what position(s) you hold in the Arizona Elks Association.
Arizona Elks Major Projects
DDGER/Leading Knight Clinic
Donate Life/Blood Drive
Elks National Foundation
Food Basket Programs
Meetings District and Above
National Disaster Relief
Official Visitation District and Above
Select a function from the dropdown menu. If function is not listed, please select "Other" at the bottom and fill in the next field with the function name.
Enter Function Name if not listed in above dropdown menu.
Number of Participants
Total Number of people that participated
Number of Elks
Number of Elks that participated
Number of Helpers (Non Elks)
Number of Helpers (Non Elks) that participated
Total Hours Planning & Attending (Elk Member)
Total hours spent planning for, working, and attending meetings, functions, Lodge Visits, and other Elk functions of a charitable nature. Elk Members Only
Total Hours Planning & Attending (Non Elk Helpers)
Total hours spent planning for, working, and attending meetings, functions, Lodge Visits, and other Elk functions of a charitable nature. Non Elk Members only.
Total mileage to & from meetings, functions, Lodge Visits, and other Elk functions of a charitable nature. Elk Members only.
Total mileage to & from meetings, functions, Lodge Visits, and other Elk functions of a charitable nature. Non Elk Members only.
Total Contributions - Non Cash (Estimated Value)
Total of Elk and Non Elk Members contributions. This can be estimated to the best of your ability.
Total of your "Out of Pocket" as well as your "Budgeted" funds
Any other items or remarks you think would pertain to Charitable Data.