Smokefree Oregon Community Map Sign-up
Smokefree Oregon's website now features an interactive map that connects anyone who accesses the website to organizations across the state that work on commercial tobacco and other related issues!

Explore the map at smokefreeoregon.com/community-map

Map users can learn more about your organization to receive quitting resources, participate in your advocacy issues, volunteer,  or just learn more about the work that your organization does.

Please complete the form below to be added to this resource map! 
Sign in to Google to save your progress. Learn more
Name of Organization *
Physical Address *
Link to Website *
Type of Partner *
Required
Communities Served (select 4 max) *
Required
Focus Area (select as many as applicable) *
Required
How People Can Get Engaged (select as many as applicable)
*
Required
Languages Offered (select as many as applicable)
*
Required
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