October 24, 2011 Workshop PROMOTING AND SUSTAINING TOBACCO PREVENTION AND CESSATION PROGRAMS

Question Title

* 1. Please complete the following section.

Name: *

Company:

Address: *

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number:

Question Title

* 2. Yes, I will attend the workshop on October 24, 2011.

	Yes
I will attend the ADH-Auditorium location	I will attend the ADH-Auditorium location Yes
I would prefer to attend by video-conference and will call for video conference location.	I would prefer to attend by video-conference and will call for video conference location. Yes

Address:
Arkansas Department of Health - Basement Auditorium
4815 West Markham
Little Rock, AR 72205

For questions concerning the workshop, please contact Beccy Secrest at 501-661-2048

Registration from 8:00 to 8:30 (light breakfast provided at ADH Auditorium location)
Workshop from 8:30 to 3:30 (lunch provided at ADH Auditorium location)

Registration closes on October 20, 2011