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Partner Agreement: Raise It for Health
This form serves as the Partner Agreement to officially join the Raise It for Health campaign. Signing the agreement allows Raise It for Health to publicize your organization or company support and use your logo for campaign purposes.
Organization or company name *
Your answer
Full address (street, city, zip) *
Your answer
Best point of contact name and title *
Your answer
Best point of contact email *
Your answer
Best point of contact phone number *
Your answer
What partner opportunities are you most interested in learning more about or undertaking? *
Required
Significantly raising the cigarette tax in Indiana would help adult smokers quit, protect kids and generate $360 million in the first year alone for urgent public health causes, including on-the-job tobacco cessation support and opioid misuse prevention and treatment. Why does your organization support raising the cigarette tax? What benefits do you see? *
Your answer
A partner toolkit will be shared with you. Would you also like a call from a Raise It for Health organizer to discuss ways to partner? *
Is there anything else you want to share?
Your answer
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