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World Smokefree May 2023 Community Workshop Series Registration
Disclaimer
By completing this form, you agree to photos and videos being taken and used for promotional purposes via our social media and websites.
1.
Please select which wananga you would like to attend
Te Taha Tinana - Thursday 4th May. 6pm - 7:30pm
Te Taha Hinengaro - Thursday 11th May. 6pm - 7:30pm
Te Taha Wairua - Thursday 18th May. 1pm - 2:30pm
2.
Are you a current tobacco/cigarette smoker?
Yes
No
3.
Does anyone in your household smoke tobacco?
Yes
No
4.
Are you currently vaping?
Yes
No
5.
Does anyone in your household vape?
Yes
No
6.
How can we contact you?
Name
Email Address
Phone Number
7.
Do you have any dietary restrictions?
Thank you for taking the time to fill in this survey and register your interest in this Smokefree wananga. We have limited spaces for each wananga, so we ask for your patience to confirm your attendance. If you are successful we will be in touch.
