NAME: ___________________________________________________
LOCATION: _______________________________________________
DATE: ________________ TIME (start/end): _____________/_______________
Title Name Signature Mileage Miles
Chair Y/N
Vice Chair Y/N
Treasurer
Y/N
Secretary
Y/N
Member
Y/N
Member Y/N
Member Y/N
Member Y/N
Member Y/N
By signing below, I verify that the attendees listed above did attend the meeting listed above
meeting at the date, location and for duration as described above.
___________________________________________ ______ __________________
Name (Printed) DATE
_________________________________________________
Signature
Pokégnek Bodéwadmik · Pokagon Band of Potawatomi
Meeting Stipend Form