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Step To Be Tobacco Free Pedometer Challenge Registration
Email address *
Name or Names if entering as group: *
Your answer
Age: *
Your answer
Phone Number:
Your answer
Category: *
Shirt Size (please pick up at PIA) *While Supplies Last* (S-3X Womens, S-3X mens, XS-XL Youth) *
Your answer
Do you need a pedometer? *
Are you a former tobacco user?
Are you a current tobacco user?
Have you quit or attempted to quit since the last pedometer challenge?
By completing this form you are agreeing to promote support and encourage tobacco free lifestyles while walking tobacco free! *
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