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.
Title of Event
Location of Event
Date of Event
Time of Event
Description of Event
Contact Person Name
Contact Person Phone
Contact Person Email
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
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).
Would you like to join our mailing list?
Yes - Coalition information
Yes - Bi-monthly newsletter
Yes - Advocacy information
Yes - TRU (Tobacco Resistance Unit -
Yes - Maternal and Child Health
Yes - Chronic Disease
Yes - Young Lungs at Play
Yes - Smoke-free Multi-unit Housing
Yes - LGBTQ
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!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service