Gift TypeOne Time DonationMonthly Recurring Gift Amount Contact Details First Name Last Name Email Phone Billing Address Address Line 1 City State/Province Postal Code CountryPlease select... United States Canada Do not add me to The Aliveness Project's mailing list.Yes Payment Information Name on Card Card Number MM YY Code Dining IN For Life Participation Questions I supported a local restaurant partner byOrdering TakeoutOrdering DeliveryDined In (safely)Ordered Gift CardsNone of the above Please list the restaurants you supported I participated in a Virtual Dinner Party this yearYesNo How did you hear about Dining IN For Life?Please select... Info from The Aliveness Project Social Media Info at restaurant, bar, or coffee shop Word of mouth City Pages Lavender Mpls St Paul Magazine Twin Cities Gay Scene Other Ambassador Name Any comments you'd like to share about your Dining IN For Life experience Contact Information
