The Official PAN Vegan Pledge • Chippewa SIGN UP FORM

This form is for people who want to take the 2013 PAN Vegan Pledge in Chippewa, WI, to go vegan. The program is FREE. However, we do require a pre-pledge phone chat before the program begins. Pledges are expected to come to all of the meetings. Mentors are expected to come to the first and last meetings.

Please use the form below if you want more information about the program or would like to sign up to go vegan with the 2013 PAN Vegan Pledge in the Chippewa, WI. If you are already a vegan and want to help with this vegan pledge, please fill out the volunteer form. A volunteer will be in touch to finalize your participation in the program.

* Required

Name (first and last) *

E-mail Address *

Phone Number *

Street Address

City, State, Zip *

Have you ever tried gonig vegan before?

Which of the following best describes your intentions for participating in the Vegan Pledge? *

Which of the following best describes your current diet? *

Why do you want to take the PAN Vegan Pledge? *

Do you have any concerns about taking the PAN Vegan Pledge? *

Do you have any special needs we should keep in mind? * For example, if you are an athlete, if you are pregnant or breastfeeding, or if you only have access to a microwave oven for preparing meals, we can try to find a mentor who best fits those needs.

Do you have any restrictions in the forms communication that you use? * For example, you can't send/receive text messages.

How did you hear about the PAN Vegan Pledge? * Word of mouth, Facebook ad, newspaper, Internet search, etc. - please let us know so we can reach more people.

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