Community Support for Smoke-free Policy in McCracken County

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* 1. Are you a McCracken County resident?

Yes

No

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* 2. Do you reside within Paducah city limits?

Yes

No

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* 3. Do you work in McCracken County?

Yes

No

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* 4. Do you work within Paducah city limits?

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.

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?

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* 7. Would you like to be contacted for volunteer opportunities to support the smoke-free ordinance in McCracken County?

Yes

No

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* 8. Contact Information

Name *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number