Sign Up Today to Begin Your TOBACCO FREE life.

Thank you for your interest in the LIVE TOBACCO FREE program, as coordinated by your LIVESMART team. To get started, you can enroll with your LIVESMART Ambassador or sign up using this form. A LIVESMART Health Coach will contact you to provide more information and help you get started on your plan to quit tobacco.

If you have any questions at any time, please do not hesitate to contact a member of your LIVESMART team. We are here to support you.

For more information, please see our website at

Wishing you health and happiness,


Question Title

(include any additional comments below the first two).  

I, commit to participating in the LIVE TOBACCO FREE campaign. By signing this pledge, I understand:

1.  Tobacco is harmful in any form and thereby commit to a healthier life for me, my family and my friends.

2. I will connect with a LIVESMART Health Coach who will assist me in developing my quit plan and support me through follow up coaching sessions (4-6 sessions throughout the year).

Question Title

* 2. Participant Information

Question Title

* 4. Current Tobacco Use

Question Title

* 5. Would you be interested in completing this campaign with other participants over the phone or on a webinar?