The Live Tobacco Free Program is 4 sessions, meeting once a week for 4 weeks, and is an hour in length. Please complete the brief survey that follows to allow us to better serve you. 

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* 1. What is your first and last name?

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* 2. What is your zip code?

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* 3. What is your e-mail address?

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* 4. What is your phone number?

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* 5. How did you hear about the program?

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* 6. Please select which program format works for you? 

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* 7. What day of the week is best for you? (select all that apply)

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* 8. What time of day is best for you? (select all that apply)

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