2019 Madison Action Day - JONAH
In order to clearly see how many people we have signed up to attend Madison Action Day (3/26/19) from JONAH we ask you to please use this form to track yourself and/or others that are attending. Please fill as much information as you have available, but please know that an incomplete entry is better than no entry.

Bus riders should arrive on Tuesday, March 26th by 5:45 am to Immanuel Lutheran Church (3214 Golf Road, Eau Claire).

If you have any questions or concerns please contact JONAH Organizer Lynn Buske (cvjonahorganizer@gmail.com). Please give registration ($35: includes event fee and bus ride + cost of t-shirt if wanted) to Lynn or mail to JONAH; 307 South Farwell Street - Suite 202; Eau Claire, WI 54701. If mailing, please make sure to include your name. Thank you!

Name of Person Attending *
Your answer
Phone Number and Email Address? *
Your answer
Address (include city)
Your answer
Is the attendee interested in riding the bus? *
Would the attendee like to purchase a Madison Action Day t-shirt (additional cost)? *
Does the attendee need a scholarship to partially or completely cover registration costs? (Can't be guaranteed, but we will try)
Does the attendee have a food allergy? (If yes, please note what type)
Your answer
Emergency Contact, with phone number?
Your answer
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