Registration for the Youth Tobacco Survey Listening Session in Kokomo, IN

Registration for YTS Listening Session in Kokomo, IN

Thank you for your interest in the Youth Tobacco Survey Listening Session in Howard County (Kokomo)!

The event will take place in Hingst Hall at Ivy Tech Community College Kokomo (1815 E. Morgan St., Kokomo, IN) on Tuesday, February 6th from 1:30-3:30 pm.

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* 1. Name:

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* 2. Email address

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* 3. County of Residence:

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* 4. Will you be bringing any family members or other guests with you? If so, please list their names below.

Guest 1 name

Guest 2 name

Guest 3 name

Guest 4 name

Guest 5 name

Registration for the Youth Tobacco Survey Listening Session in Kokomo, IN

Registration for YTS Listening Session in Kokomo, IN

Question Title

* 1. Name:

Question Title

* 2. Email address

Question Title

* 3. County of Residence:

Question Title

* 4. Will you be bringing any family members or other guests with you? If so, please list their names below.

Question Title

* 5. What questions do you have about youth tobacco use (including vaping) that you would like to have answered during the event?