2018 Allegheny Quits for Life - Partner Form
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.

We're looking for organizations who would like to get involved! This includes:
- Any organization who will share cessation resources, like the PA Free Quitline, during the week of November 11-17, 2018.
- Organizations who will share resources on their social media pages.
- Organizations that are interested in planning and hosting a tobacco-free and/or cessation awareness event.

Share your information below and we'll provide you with free resources!

Organization Name *
Your Name: *
Address
Phone Number *
Email *
Are you able to share your organization's logo to be used on partner documents (flyers, websites, etc.)?
Attach logo here (multiple logos are allowed)
Is your organization on social media?
Please include usernames for any above accounts for tagging.
How will you be involved in Allegheny Quits for Life? *
Required
Events
If you are interested in planning/hosting an event during Allegheny Quits for Life, please ALSO complete the event form located here: https://goo.gl/forms/nANSP0GcST3sDRin1 (link will open in new window.)
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