EmailMe Form - In-Action Community Thanksgiving Day Dinner

Who are the meals for:

Myself

A family member

A friend

Please fill out the information below for the person receiving the meal(s).

Name: *

First Last

Email

Select the Closest Area in which you live *

Logan, Stollings, Peach Creek, Rt 44, Holden, Whitman, or Mud Fork

Chapmanville, Big Creek, Harts, Pecks Mill, Lake

Man, Lyburn, Buffalo Creek, Cyclone

Boone County

Physical Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

### - ### - ####

Cell Phone

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Age

Meal Type *

Delivery to your Home

Dine-In

Pick-Up

If planning to Dine-In or Pick-up select a location

Chapmanville Middle School

West Logan Church of God

Man Church of the Nazarene

Scott High School

Number of Meals Requested *

Select the number of Meals Needed for Address

Directions to Home: *

Please provide detailed driving directions to the delivery location from your local meal site.

Special Instructions

Any special delivery instructions such as hard hearing, elderly, beware of dogs? Please know delivery times can not be requested as deliveries are made by volunteers.

Person submitting form:

First Last

Your phone number:

### - ### - ####