AOH Shield Ancient Order of Hibernians
Missions and Charities
Report Form

Page 1 - Single Event Report
Please print and mail to address below.

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Use page 1 of this form to submit a one time fund raiser.
Use page 2 of this form to submit Quarterly, Semi-
Annual, or Annual Reports.
Click here for page 2.
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Division Name:________________________________________
Division Number:______________________________________
Number of Members in Division: _________________________
County:______________________________________________
Date Of Event:________________________________________
Dollar Amount of Donation:______________________________
Name of Charity or Organization:__________________________

List any comments you might like to share:___________________
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If you’re reporting man hours list the number of members that participated and the total hours.
Number of Members:________________________________
Number of Hours___________________________________

Person Submitting This Report________________________
Address__________________________________________
City, State and Zip _________________________________

Mail To: Arnold J. Nagelhout
8422 Munson Avenue
Niagra Falls, NY 14304-3441