Request edit access
Allegheny Quits for Life Event
What is Allegheny Quits for Life? It's a partnership with community organizations, led by Tobacco Free Allegheny and the Allegheny County Health Department, to promote the free cessation resources available to Allegheny County residents. What are we looking for in an event? We're looking for organizations who will include cessation resources, like the PA Free Quitline, in any events they may be doing November 12 - 18. We're looking for organizations who will share resources on their social media pages. Share your information below and we'll provide you with resources you can include at your event.
Organization
Your answer
Title of Event
Your answer
Location of Event
Your answer
Date of Event
MM
/
DD
/
YYYY
Time of Event
Time
:
Description of Event
Your answer
Target Audience
Your answer
Contact Person Name
Your answer
Contact Person Phone
Your answer
Contact Person Email
Your answer
Is this event open to the public?
Would you like Quitline materials sent to you before the event?
If yes, please provide us with your mailing address
Your answer
Would you like Allegheny Quits for Life t-shirts for you event staff?
Please indicate the number for each size you would like (S, M, L, XL, XXL available).
Your answer
Would you like to join our mailing list?
Thank you!
Community partners like you are what make Allegheny Quits for Life great! Please be sure to tag any social media posts about your event with #AlleghenyQuitsforLife so we can see them and share them with our audience as well. Good luck with your event!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms