Exit this survey 3SquaresVT Challenge Registration Thank you for your interest in taking the 3SquaresVT Challenge and being willing to eat on a limited food budget for a week, day, or meal. Please fill out this short registration form. Question Title 1. Name Question Title 2. Organization (if any) Question Title 3. Town where you live Question Title 4. Email address (where you'd like to receive updates and important information about the Challenge) Question Title 5. Are you taking the challenge for a week, a day, or a meal? Week Day Meal Question Title 6. How many people in your household will be taking the Challenge? 1 2 3 4 Other (please specify) Question Title 7. Tell us why you’re doing the Challenge or what you hope to learn: Question Title 8. How did you hear about the 3SquaresVT Challenge? Email invitation Facebook invitation Hunger Free Vermont Website Teacher/Class Media (newspaper, radio, tv) Word of Mouth Other (please specify) Question Title 9. How will you share your experience of doing the Challenge with others? Post on Challenge Facebook Page Submit a Letter to the Editor Talk about it with friends, family, classmates or colleagues Email VT Lawmakers about the importance of the program All of the above Other (please specify) Question Title 10. Local reporters sometimes like to interview Challenge participants in various regions of Vermont. Would you be willing to be contacted for a telephone or in person interview? Hunger Free VT would check with you first before connecting a reporter with you. Yes No Maybe Comments Question Title 11. Comments/Questions? Next