REGISTER 2021 – Mobilize Against Tobacco Lies

Registration 2021

Check whether you would like a toolkit mailed to you. Includes a t-shirt and other gear. Cost will be $25.00 for each toolkit. A digital toolkit will be available for download for free on the website. *

I would like to purchase a toolkit to be mailed to me. I will receive a bill for $25.00

I will be downloading and using the digital toolkit.

Check the first box if you are registering as an individual. Check the second box if you are a group leader and would like to request a form to register a group. *

I am registering as an individual

I am registering as a group leader and would like to register a group

Name *

First

Last *

Last

Email Address *

Phone Number

Primary

Mailing Address *

Mailing Address

Street Address

Apartment/Building/Suite #

City

State/Province

Zip/Postal

Country

Message: If you will be purchasing a mailed toolkit, please enter your t-shirt size here in the message box. Thank you

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