Tobacco Community Survey Drawing 2023

Thank you for completing the Tobacco Community Survey, we appreciate your feedback and opinions. To be entered in the drawing for a Kroger gift card, please complete the information below. Your name will not be linked to the answers provided in the Tobacco Community Survey

Question Title

* 1. Please enter your contact information below to be entered in the drawing.

Por favor, anote su informacición de contacto para participar en el sorteo

Name (Nombre)

Address (Dirección)

Address 2

City/Town (Ciudad)

State/Province(Estado)

ZIP/Postal Code

Email Address (Correo Electrónico)

Phone Number (Número de telef.)

Tobacco Community Survey Drawing 2023

Question Title

* 1. Please enter your contact information below to be entered in the drawing. Por favor, anote su informacición de contacto para participar en el sorteo

* 1. Please enter your contact information below to be entered in the drawing.

Por favor, anote su informacición de contacto para participar en el sorteo