Clearing the air and breaking the addiction!
RequiredRequired Question(s)
Required 1.
Your information

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Postal Code:

2.
Which topics interest you most?
Tobacco prevention programs for children and youth
Health impact of tobacco use
Secondhand smoke exposure
Policy (tobacco-free grounds, cigarette tax, clean air standards, etc.)
Smoking and pregnancy
Smoke-free housing
Helping smokers quit
Other  
3.

What's your story? Please use the comment section if you have been affected by tobacco in one of these ways:

Quitting tobacco
Secondhand smoke at a workplace
Losing a loved one to tobacco-related disease
Other  
  • Comment:

  • 500 characters left.
4.

Are there specific issues that you would like Tobacco Free Johnson County to address?

 

350 characters left.
5.

Would you like to receive quarterly email updates of tobacco work in Johnson County? 

Yes
No
Thank you for your support of Tobacco Free Johnson County!