For more information about the Great American Dine Out, click here »

Restaurant/Company/Franchise Information

Restaurant Name or Brand Name*

What is your corporate or franchise name?

Number of participating restaurants

Restaurant Type*

Select One... Independent Operator Multi-unit Corporate Multi-unit Franchisee Other If Other...

Restaurant Category*

Select One... QSR Casual Dining Upscale Dining Fine Dining

Address*

City*

State*

Select One... Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip*

Phone*

Web Site

Restaurant Key Contact

First Name*

Last Name*

Title

Phone

Email*

Referral Information

How did you hear about the Great American Dine Out?*

Select One... National Restaurant Association Share Our Strength Other Food Network Nations Restaurant News OpenTable SYSCO State Restaurant Association Fishbowl Marketing QSR Magazine groupdyne If Other...

Name of Referrer

Your Level of Participation

Fundraising*

Select One... Donate a percentage of sales Create a bounce back coupon offer Create a donation card Special menu promotion Merchandise sales Other
Other/Percentage of Sales

Pledge

Pledge Amount

(suggested minimum donation $100 per location)

Sponsor Information

Are you a Sysco Customer?

Yes No

If Yes, please provide the following information, available on your SYSCO invoice.

Sysco Operating Center

Select One... Albany Arizona Arkansas Asian Foods (St. Paul, MN) Atlanta Austin Baltimore Baraboo Central Alabama (Calera, AL) Central California (Modesto) Central Florida (Orlando Area) Central Ohio (Columbus) Central Pennsylvania (Harrisburg) Charlotte Chicago Cincinnati Cleveland Columbia Connecticut Dallas Denver Detroit East Wisconsin (Jackson) Grand Falls Grand Rapids Gulf Coast (Geneva AL) Hallsmith (Boston) Hampton Roads Hardins (Memphis) Houston Idaho Indianapolis Intermountain (Salt Lake City) Iowa Jackson Jacksonville Jamestown Kansas City Kingston Knoxville Lankford Las Vegas Los Angeles Louisville Metro New York Minnesota Moncton Montana (Billings) NASYS New Mexico (Alburquerque) New Orleans North Dakota (Fargo) North Douglas Northern New England (Westbrook, ME) Oklahoma Pegler (Lincoln, NE) Philadelphia Pittsburgh Portland Raleigh NC Regina Robert Orr (Nashville) Robert's (Lincoln, IL) Sacramento San Antonio San Diego San Francisco Seattle South Florida (Miami) Southeast Florida (Riveria Beach) Spokane St Louis St. Johns Sturgeon Falls Syracuse Thumder Bay Ventura Virginia Watson (Lubbock, TX) West Coast Florida (Palmetto, FL)

Thank you for registering for the 2010 Great American Dine Out

A Dine Out staff member will contact you shortly. In the meantime, If you have any questions, please contact Jessie Sherrer or call (202) 478-6505.

If you are a multi-unit restaurant, you will receive a spreadsheet to fill out. Please complete this spreadsheet so all your locations are represented on our Find A Restaurant. Google map.

Thanks to our 2010 national sponsors!

These generous companies provide support to the Great American Dine Out in a variety of ways. They are critical to meeting Share Our Strength's goal of ending childhood hunger in America by 2015.

• Sysco
• American Express
• Ecolab
• Jacob's Creek
• USA Today
• National Restaurant Association

Learn more about them, and how they help.