SurveyMonkey Powered Online Survey

Whether you dip, chew or smoke, you can quit! Explore the reasons why you use tobacco and discover strategies to help you stop! Free materials and nicotine replacement will be provided, in a supportive, relaxed environment. This year, give yourself the gift of health!

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* 1. Last Name

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* 2. First Name

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* 3. Worksite

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* 4. SAP number

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* 5. Email address

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* 6. Telephone Number

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* 7. Please sign me up for the Quit Smoking Now class below:

Quit Smoking Now (5-week class, meets 1-hour per week), Tuesdays, 2/2, 2/9, 2/16, 2/23 and 3/1, at Travis Career Media Center, Lakeland, 4:00-5:00pm