Affiliate Financial Assistance Program Funds Usage Report Question Title * 1. Affiliate Society Name: Question Title * 2. Affiliate Society Name: Question Title * 3. Were the funds used to support your annual meeting? Yes No If yes, how much? Question Title * 4. Were the funds used for continuing education programs? Yes No If yes, how much? Question Title * 5. What types of continuing education programs or activities were purchased? Question Title * 6. Were the funds used to purchase equipment, software, or other office related material? Yes No If yes, how much? Question Title * 7. What type of equipment, software, or other office related material was purchased? Question Title * 8. Other than the options listed above, what programs, initiatives, and/or items were the funds used for? Question Title * 9. Additional comments: Question Title * 10. I acknowledge that I am the president of my affiliate society. Yes Please type your name to serve as your digital signature: Done