Smoke-Free Housing RSVP

Smoke Free Housing Lunch & Learn Event

Please complete the questions below to register for the FREE smoke-free housing lunch and learn event on October 18, 2012 from 11:30-1:00 in Fairmont, MN at the Pizza Ranch.

Question Title

* 1. I plan to attend the lunch and learn session in Fairmont.

Yes

Maybe

Other (please specify)

Question Title

* 2. Please tell us who you are

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country:

Email Address: *

Phone Number: *