2023 Tobacco Conference Waiver Form

Name *

First

Last

Work Email *

Job Title *

Organization *

Organization Website *

Organization Type *

• 501(c)(3) Public Health Advocacy Organization
• Academic
• Other (describe below)

If other, please describe

How will you attend the event? *

• In-Person
• Virtual

Please describe your role and your organization's work as it relates to tobacco and nicotine products.

Name

Submit

Hannah Brown2023-04-24T10:40:42-04:00