Fraternal Commitment:

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Your name:	Date	Event

1. Number of visits to:
a. Sick
b. Bereaved
2. Number of blood donations:
3. Number of hours:
a. Church:
b. Community:
c. Youth:
d. Habitat for Humanity:
e. Miscellaneous:
4. Fraternal service:
a. Members and their families (hours):

Please add any comments to describe event (i.e., date, location, title, organizer, etc.):