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

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1. Please complete the following section.

Please complete the following section. Name:
Company:
Address:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

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

	Yes
I will attend the ADH-Auditorium location	*Yes, I will attend the workshop on October 24, 2011. 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

October 24, 2011 Workshop PROMOTING AND SUSTAINING TOBACCO PREVENTION AND CESSATION PROGRAMSExit this survey

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