These Kentuckians and Hoosiers Stopped Smoking. So Can YOU!
TheseKentuckians and HoosiersStopped Smoking.So Can YOU!

Application for Recommendation

If you operate or manage a stop smoking program within the states of Kentucky and/or Indiana, and if you wish to apply for a recommendation of your program by Stop Smoking Kentucky and Stop Smoking Indiana, please use the form below.  We will provide you with the requirements and explain the application process.

 

Your form message has been successfully sent.
You have entered the following data:

Information for Recommendation / Preliminary Information Form

Please correct your input in the following fields:
Error while sending the form. Please try again later.

Note: Fields marked with * are required

NOTE:  Within this website, we use the term “smoking” and “cigarettes;” however, the methods and programs discussed apply to tobacco use in all its forms including chewing and dipping.

Print | Sitemap
© Stop Smoking Kentucky / Stop Smoking Indiana--This website is maintained as a public service and is neither financed by nor associated any governmental agency. Images of people are for illustration purposes only and are used with permission. They are not intended to depict actual individuals.