Tobacco Retailer Training Registration

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* 1. Name

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* 2. Store Name

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* 3. Store Address

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* 4. City

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* 5. Phone Number

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* 6. Email Address - To send Zoom link

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* 7. Check One

Clerk

Manager

Owner

Other

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* 8. Check One

Gas Station

Convenience Store

Grocery/ Drug Store

Other

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* 9. Select Training Date/Time

May 20th at 10am

Cost is $25 per person. Mail check to CASA prior to training day. 7839 University Ave Suite 107 La Mesa CA 92142