QUIT TOOLKIT ORDER FORM

DID YOU KNOW?  Tobacco use is still the No. 1 cause of preventable morbidity and mortality in the United States and kills one of every five people in the United States.
 
The Quit Toolkit is designed to provide our Partner organizations with a convenient way to inform employees, customers and other audiences about the free tobacco cessation resources available through the Indiana Tobacco Quitline (1-800-QuitNow).   

 EACH QUIT TOOLKIT CONTAINS

·         Talking points to aid Partners in communicating the importance and urgency of quitting  
           and information on how the Indiana Tobacco Quitline can help individuals quit for life.

·         Quit Now Indiana Frequently Asked Questions & Answers

·         Brochures with information about the Indiana Tobacco Quitline services; and

·         Local contact information for Tobacco Free Delaware County.

This Quit Toolkit was developed by the Healthy Community Alliance and Tobacco Free Delaware County as a strategy to improve the health outcomes of individuals living in Delaware and Blackford County, Indiana.  This resource is free for Healthy Community Alliance Partner organizations and is part of a community-wide effort to engage residents in healthier behaviors, including the reduction of tobacco use. 

For more info on the Healthy Community Alliance visit: http://www.healthycommunityalliance.org/

TO PLACE YOUR ORDER, SIMPLY COMPLETE THE FORM BELOW AND CLICK SUBMIT!  THANKS FOR YOUR SUPPORT.

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* 1. Name (First, Last)

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* 2. Title

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* 3. Organization Name

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* 4. Mailing Address 

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* 5. Phone Number/Ext.

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* 6. Email Address

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* 11. How do you intend to use the Quit Toolkit?

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* 12. Would you like more info about becoming an Indiana Tobacco QuitNow Preferred Provider Network?

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* 13. Please list your office hours.

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