The University of Texas MD Anderson Cancer Center's Certified Tobacco Treatment Training Program

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The University of Texas MD Anderson Cancer Center's Certified Tobacco Treatment Training Program - Arkansas Cancer Coalition

Registration for the Certified Tobacco Treatment Training Program. To be hosted online from April 19th - 23rd, 2021. Please complete the below form and submit by March 26th, 2021.

Email *

First Name *

Last Name *

Degree *

Department *

Employer's Name *

Street Address (Home) *

City (Home) *

State *

Zip Code (Home) *

Phone *

Dietary Restrictions *

Thank you for completing the Certified Tobacco Treatment Training Program registration form. Please note there are two required forms that must be completed prior to April 9th: Media Release Form and Tobacco Attestation Form.

A copy of your responses will be emailed to the address you provided.

Submit

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