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Tobacco and Nicotine Use Among Youth: Presentation and Slide Deck Request Form
Please fill out this form if you would like to request a presentation and/or the slide deck about youth tobacco and nicotine use.
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Email
*
Your email
Name of Requestor
*
Your answer
Organization Name
*
Your answer
What are you requesting? Select all that apply.
*
Facilitated Presenter (presenters based on availability).
Slide Deck
Electronic Nicotine Delivery Systems show-and-tell products
Required
Presentation Date
MM
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DD
/
YYYY
Presentation Location (Town/City, State)
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Your answer
Anticipated Audience
Students
Parents
Teachers
Other:
Anticipated Location
Your answer
Please describe any specific information you are requesting
Your answer
Estimated number of attendees
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A copy of your responses will be emailed to the address you provided.
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