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Membership Form

Thank you for your interest in the Tobacco Free Ohio Alliance (TFOA). Membership is open to all organizations and individuals concerned about the detrimental health consequences of tobacco use and interested in furthering the mission of TFOA. Please complete the following membership form.
1.Salutation:
2.First Name:(Required.)
3.Last Name:(Required.)
4.Credentials (check that all that apply):
5.Position/Title:(Required.)
6.Organization/Agency:(Required.)
7.Department:
8.Street Address:(Required.)
9.City:(Required.)
10.State:(Required.)
11.Zip Code:(Required.)
12.Phone:(Required.)
13.Email:(Required.)
14.Select one or more of the following that apply to you:(Required.)
15.Please provide a brief overview on why membership is requested. This will be read at the next membership meeting prior to voting.(Required.)