Please fill out the following form and submit one week from date of visit. Is this an Original or an Amended report? Original Amended Date of Visit Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027 Name (Member attending site visit) NALA Materials Sent Type of Visit/Event Affiliated Association Event Tradeshow Event School or Other Event Information Affiliated Association or Tradeshow Name Name/Title of Event Location City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Contact Person Name Phone Number Email Attendance (Actual or estimate) Door Prize Winner's Contact Information Sent to Headquarters? Yes No Door Prize Winner's Name Prize Drawing Slips/Business Cards Given to Headquarters? Yes No Value Added/Positive Take-a-ways for NALA Any Booth or Visit Issues or Concerns? Areas of Improvement - How can we make it better? Follow-up or Pending Items Comments Accident/Incident During your travel on this visit, were you involved in any accident or incident? Yes No Please submit an accident report to the Executive Director. Submit
