Reality Check of St. Lawrence, Jefferson and Lewis Counties is a movement led by a dedicated group of 13-18 year old leaders who work to expose the manipulative marketing tactics used by the tobacco industry to target teens. We educate our community, peers, and policy makers with the goal of mobilizing change that will de-normalize tobacco use in our society.
Once the application is completed, a parent consent form will be mailed to your address to be reviewed, signed and returned to:
Jenna DeDonato, Reality Check Coordinator
Seaway Valley Prevention Council
206 Ford St. Suite 301
Ogdensburg, NY 13669
Thank you!

* 1. What is your full name?

* 2. What is your age?

* 3. What grade are you in?

* 4. Mailing address

* 5. Phone number

* 6. E-mail address

* 7. Parent/legal guardian name(s)

* 8. Parent/legal guardian phone number

* 9. What is your preferred method of contact?

* 10. What is your favorite activity?

* 12. Birthday?

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