Registration

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Thank you for your interest in hosting a Great American Smokeout (GAS) activity on your college campus.
Please complete the following information to register for quit kit materials, printed materials, and/or advertisements.

Registration for this event closes on October 31, 2016.

Sometimes more than one campus representative will register for materials. If more than one person from your campus registers, we will contact you so you can coordinate efforts.

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* 1. Contact Information

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* 2. Address where materials should be shipped:

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* 3. Campus(es) where materials will be distributed:

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