"Let's Clear the Air" Smoke Free Places Pledge

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* 1. Full Name (required)

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* 2. Mobile Number

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* 3. Do you identify as?

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* 4. Are you currently a?

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* 5. Number of people living in your home that benefit from cleaner smoke-free air?

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* 6. What's your reason for signing the "Let's Clear the Air" pledge?

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* 7. I pledge to ( please tick all the boxes you are pledging to achieve):

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* 8. Where did you hear about the " Let's Clear the Air" Smoke-Free pledge?

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