I'm "Dining In" on December 3rd!
Make a commitment on behalf of yourself, your family, or your group to "Dine In" device free on or during the week of Dec. 3, 2018.
What is your first name or name of your group? *
Your answer
What is your last name?
Your answer
What city do you live in? *
Please provide so you can be included on the interactive map.
Your answer
What state/territory do you live in? If not listed, please choose "Other." *
What is your 5 digit zip code? *
Please provide so you can be included on the interactive map.
Your answer
What country do you live in?
Your answer
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.
Your answer
I'm making a commitment on behalf of *
If you would like to be eligible for prize drawings, please provide your email address.
Your answer
How did you hear about this campaign?
If applicable, name the specific person who informed you about FCS Day.
Your answer
If applicable, select the specific organization(s) that informed you about FCS Day or fill in "Other."
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