Support Our Efforts

Thank you for joining Colorado Breath.
Please note that this form has been deactivated.

Protect yourself from secondhand smoke!

Name

Address

City

State

Zip

Phone

E-mail

Employment Workplace

Job Title

Comments

PleaseAdd me to your e-mail list.

Please keep my name confidential.

I am: An Employee An Owner A Manager A Patron

I would like to help (check all that apply):

Endorse your efforts to make all public places and workplaces smoke-free and allow the use of my name online.

Circulate petitions.

Distribute information to establishment owners, workers, the public.

Write letters to the editor, city council, etc.

Appear or speak at press conferences, in press releases, to the media.

Willing to speak to the media.

Staff booths at fairs, conferences, or workshops.

Help stuff letters, or other general clerical work.

Other (please specify)

 

Working towards creating a safe and healthy workplace free of tobacco smoke.