COMMIT TO QUIT!
Fill out a quick survey to take the first step.
Your Name:
*
First Name
Last Name
Location/Work Group
*
Please Select
Newport News Shipbuilding
Ingalls Shipbuilding
Technical Solutions Division
Your Email:
*
example@example.com
I plan to quit smoking on:
*
November 18 - Great American Smokeout Day
Another date of my choosing
What date are you making the commitment to quit:
-
Month
-
Day
Year
Date
Your plan of action to quit smoking:
*
Sign me up for the Freedom from Smoking class beginning in February!
*
Yes! I will be joining the Freedom from Smoking program beginning Monday, February 14th.
I'd prefer not to participate in the Freedom from Smoking program at this time.
Sign me up for the Freedom from Smoking class beginning in February!
*
Yes! I will be joining the Freedom from Smoking program beginning Tuesday, February 15th.
I'd prefer not to participate in the Freedom from Smoking program at this time.
I'm ready to start and am interested in learning about one-on-one smoking cessation and/or individual support.
*
Yes
No
Submit
Should be Empty: