Annual Income Expense Summary Report Form

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401 N Michigan Avenue Chicago, IL 60611 800/245-7462 FAX: 312/673-6694 Annual Income & Expense Summary Report Form Regional Society (Name/#): Regional Tax ID #: Regional Treasurer: E-Mail: Daytime Telephone: ( Fiscal Period: ) to December 31, 2008 $ $ January 1, 2008 Beginning Bank Balance (01/01/2008) Ending Bank Balance (12/31/2008) INCOME Dues Educational Meetings Contributions Other Income $ $ $ $ TOTAL INCOME: EXPENSE Committees Educational Meetings Printing & Postage Other Expenses $ $ $ $ + $ TOTAL EXPENSE $ Please complete and return to address below by February 9, 2009. If you have any questions regarding the above, please contact SGNA Headquarters, at 800/245-7462 or sgna@smithbucklin.com. SGNA Headquarters 401 North Michigan Avenue Chicago, IL 60611-4267

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