Please complete the below COI Activity Report and click on the submit button at the bottom of the form.  If you have made multiple presentations at various events, you will need to complete the form for each event. If you have any questions regarding the completion of this form, contact:

Mr. George James at (910) 396-8706.  

School Name	*
School City	*
School State	*	- - Choose One - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
COI Assisting (name)	*
Type of COI Assistance	*
Event/Name	*
# of Attendees	*
Date of Event	*