* 1. Indicate type of activity completed (choose all that apply):

* 2. Please provide brief description of event/activity

* 3. Date(s) of event/activity

* 4. Total number of people reached in person (see below for media impressions):

* 5. Total CattleWomen hours volunteered for event/activity:

* 6. Total number of CattleWomen who participated in event (including yourself)

* 7. Total media impressions (if applicable)

* 8. Your Name:

* 9. Your local CattleWomen group (if no local or state org, please skip):

* 10. Your State:

* 11. Your Phone:

* 12. Your email:

* 13. Was your state beef council involved in this activity/event?

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