Your (AG) Name
Visited Club Name
Your Email Address
Your Lt. Governor's Name
Your Lt. Governor's Email Address
Date of Visit
Club's biggest success since last visit
Club's biggest challenge since last visit
Any new club PR activities?
Successful actions to increase membership?
How is board of directors functioning?
Your sense of the club during your visit
How were you received by the club?
Check all that apply
Visited Weekly Meeting
Visited Board Meeting
Visited Other Club Activity
Briefly Describe Activity
Overall Comments on Visit