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Community Support for Smoke-free Policy in McCracken County
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1.
Are you a McCracken County resident?
(Required.)
Yes
No
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2.
Do you reside within Paducah city limits?
(Required.)
Yes
No
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3.
Do you work in McCracken County?
(Required.)
Yes
No
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4.
Do you work within Paducah city limits?
(Required.)
Yes
No
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5.
I support a comprehensive smoke-free ordinance protecting employees, patrons and visitors from exposure to secondhand smoke and aerosol in all indoor workplaces and public places in McCracken County.
(Required.)
Yes, I agree
I disagree
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6.
How has secondhand smoke or e-cig aerosol impacted you? Why are smoke-free workplaces and public spaces important to you?
(Required.)
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7.
Would you like to be contacted for volunteer opportunities to support the smoke-free ordinance in McCracken County?
(Required.)
Yes
No
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8.
Contact Information
(Required.)
Name
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Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
