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smoke-free home
Smoke-Free Car
  
Media Campaign
  
pledge

Pledge to make your home and car smoke-free
FREE - Smoke-Free House and Car decals when you sign up
WEEKLY DRAWINGS for some of these great prizes

    • Stanley Steemer---$300 air duct cleaning service
    • Colvin Cleaners---$250 blind/drapery cleaning service
    • Delta Sonic---$180 car detail package
    • Patrician Room---Day Spa package
    • Feel Rite---$50 store gift certificate
    • Trillium Courtyard Florist---floral arrangement

I PLEDGE TO MAKE MY HOME AND CAR SMOKE-FREE
By submitting the form, I agree that I will make my home and car smoke-free.
By submitting this form you will be sent by mail smoke-free home and car decals and will enter
a weekly random drawing for prizes mentioned above.

I PLEDGE TO MAKE MY HOME AND CAR SMOKE-FREE
your email address
first name last name
street city
or town

state zip  

Phone (best number day)

Phone (best number evening)
I am 18 years of age

Your pledge is being sent to or you can fax or mail this application to:
Smoke-Free and Win Contest
Erie-Niagara Tobacco-Free Coalition
Roswell Park Cancer Institute,
Carlton House—A112
Elm & Carlton Streets
Buffalo, NY 14263

or,Fax to: (716) 845-8904