District 12 Extension Fee Based Program Report

Today's Date*
MM slash DD slash YYYY
Event Name*
Contact Name - Lead Agent*
Type the name of the lead agent for this event.
Event Date*
Please select the first day of the event. If your event was conducted on multiple dates, please check YES below.
MM slash DD slash YYYY
Additional Dates?*
- Yes
- No
Additional Event Dates
Please list the additional dates of the event (mm/dd/yyyy).
Registration Fee*
Please type the amount charged per participant.
Number of Registrants*
How many participants attended your event?
Total Registration Fees Collected*
(This field is auto calculated based on your entries.)
Total Amount for Fee-Based Program (under 100)*
(This field is auto calculated based on your entries.) The amount of the deposit sent to AgriLife Banking & Receivables. ($10 per person or 10% of the total, whichever is greater.)
Total Amount for Fee-Based Program (over 100)*
(This field is auto calculated based on your entries.) The amount of the deposit sent to AgriLife Banking & Receivables. ($10 per person or 10% of the total, whichever is greater.)
Scenario used for this event?*
- #1 - Local Committee
- #2 - District Workshop Account
Difference (under 100)*
Difference (Over 100)*
Is there anything regarding this event which you need the District Office to know? If so, please type it here.
Email address of person filling out this form*