Tobacco Use in Benton County- Community Presentation

* 1. Contact Information

Name

Organization

Email Address

Phone Number

* 2. Are there any specific topics you would like to discuss or questions you would like addressed at this event?

* 3. Would you like to receive additional information about the event?

Phone call

Email

I do not need any more information at this time

Other Comments or Questions:

* 4. Lunch will be provided. Do you have any dietary restrictions?

No

I will not need a lunch

Yes

(please specify)

* 5. Will you be staying to participate in the Positive Community Norms Campaign Work group with the Benton County Substance Use Prevention Coalition from 12pm-1pm?

Yes

No