Thank you for volunteering to become a Retail Data Collector with the Sacramento County Tobacco Education Program! Your assistance is greatly appreciated. Please take a moment to complete the registration form below. Thanks!

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* 1. Last Name

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* 2. First Name

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* 3. Organization/Affiliation

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* 4. Email Address: (We will only contact you about retail data collection and will not distribute your email address to any additional listservs)

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* 5. Work Phone Number

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* 6. Cell Phone Number: (Please provide a number where we can reach you when you are out in the field collecting data. This number will only be used to contact you regarding field data collection). If you do not have a cell phone, please write N/A.

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