Pottawattamie County Tobacco Prevention Coaltion Individual Endorsement

I recognize that secondhand smoke is a serious threat to workplace safety and public health. I support a policy that would make ALL workplaces and public places 100% smoke-free to protect ALL citizens.

Individual Endorsement - PCTPC

Name:

* Address:

City and Zip Code:

* Phone Number:

* Fax Number:

* E-mail Address:

I work in Pottawattamie County?
Yes

No



I live in Pottawattamie County?
Yes

No



What smoke-free air means to me . . .

Signature and Date:

(your name will not be published)

* Optional Information


© Copyright 2010 Pottawattamie County Tobacco Prevention Coalition, All rights reserved.