2021 Dining Out For Life - Donation Form 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 Out For Life Participation Questions 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 I supported a local restaurant partner byOrdering TakeoutOrdering DeliveryDined In (safely)Ordered Gift CardsNone of the above Any comments you'd like to share about your Dining Out For Life experience reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Contact Information
