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Jackson Area Legislative Dinner RSVP
Monday, November 2 at Char Restaurant
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1.
What is your first name?
(Required.)
*
2.
What is your last name name?
(Required.)
*
3.
Please check one
(Required.)
Member of MS House of Representatives
Member of MS Senate
MDA Member Dentist
Other (please specify)
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4.
Will you attend the MDA Legislative Dinner on Monday, November 2 at Char Restaurant (4500 I55 North Frontage Road, Jackson, MS)?
(Required.)
Yes
No
Other (please specify)
5.
Please list any food allergies we need to be aware of.
