I'm "Dining In" on December 3rd!
What is your name?
If you are registering for a group, use the Group Name.
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What city do you live in?
Please provide so you can be included on the interactive map.
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What state do you live in?
What is your 5 digit zip code?
Please provide so you can be included on the interactive map.
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What country do you live in?
How many people are participating at your location?
For example, if you are completing this form on behalf of a group or class, state the number of students/individuals who are participating.
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I'm making a commitment on behalf of
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How did you hear about this campaign?
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