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

Registration for YTS Listening Session in Madison, IN

Thank you for your interest in the Youth Tobacco Survey Listening Session in Madison, IN!

The event will take place at Ivy Tech (Ivy Tech Madison - 590 Ivy Tech Drive, Madison, IN 47250 Rm: 1355/1375) on Thursday, October 26th from 4-5:30 pm.

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.

Guest 1 name

Guest 2 name

Guest 3 name

Guest 4 name

Guest 5 name

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

Registration for YTS Listening Session in Madison, 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?