Survey - Sign-Up Sheet to Support a Tobacco Free Coachella

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Sign-Up Sheet to Support a Tobacco Free Coachella

Please sign up for more information on how you can help reduce the rate of tobacco usage within the LGBTQ community, help prevent the youth from smoking, and promote tobacco free environments.

Name:

First Required	Last Required

Email: Required

Yes, I would like to receive e-mail from the American Lung Association

Yes, I would like to receive postal mail from American Lung Association

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Question - Not Required - Your Cell Phone

Question - Not Required - Volunteer opportunities include data collection, developing social media, educating policymakers, community outreach activities, etc.

	Data Collection
	Social Media
	Educating Policymakers
	Community Outreach (Attend Community Events and Help Plan Tobacco Free Events)

Question - Not Required - If interested in assisting with something not listed above, please let us know below what you would like to help with!