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Community Support For Smoke-free In Corinth
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1.
Do you live in the city of Corinth?
(Required.)
Yes
No
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2.
Do you work in Corinth?
(Required.)
Yes
No
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3.
Where did you see this information or scan the QR code from?
(Required.)
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4.
I support a comprehensive smoke-free ordinance protecting employees, patrons, and visitors from exposure to secondhand smoke and secondhand aerosol in all indoor workplaces and public places in Corinth.
(Required.)
Yes, I agree
I disagree
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5.
How has secondhand smoke or secondhand e-cig aerosol impacted you? Why are smoke-free workplaces and public spaces important to you?
(Required.)
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6.
Contact Information
(Required.)
Name
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
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7.
Would you like to be entered to win a $50 gift card for participating in this survey?
(Required.)
Yes
No
Thank you for your participation.
We will notify you through your contact information if you won a gift card. The drawing will be August 1st.