I'm "Dining In" on December 3rd!
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What is your name? *
If you are registering for a group, use the Group Name.
What city do you live in? *
Please provide so you can be included on the interactive map.
What state/territory do you live in? If state not listed, choose "Other." *
What is your 5 digit zip code? *
Please provide so you can be included on the interactive map.
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.
I'm making a commitment on behalf of *
If you would like to be eligible for prize drawings, please provide your email address.
How did you hear about this campaign?
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