Wisconsin Tobacco Prevention & Control Coalition Membership Form

Welcome to the Coalition!

Thank you for answering a few questions that will help us better understand you and your tobacco control and prevention interests and expertise.

We will not sell or share this information with others. It will only be used for the following purposes by the Coalition:

1. Member communications (e.g. Coalition newsletter, requests for input, etc.)

2. Targeted action alerts by interest, topic and/or geographic area (e.g. legislative forum announcements in a certain district, etc.)

3. Coalition management evaluation (e.g. analysis of membership trends, demographics, etc.)

Individual not affiliated with an organization (such as a concerned citizen)

Individual employed by or volunteering for an organization (such as a health department employee)

Organizational membership (an organization that supports the mission of the organization)