Sign the SmokeFree Baytown Support Form

Individual/Organizational Agreement Supporting a SmokeFree Baytown
  • Because secondhand smoke contains known cancer-causing toxins and causes respiratory illness, heart disease and cancer in non-smokers;
  • Because I or my organization is concerned about the harmful effects of exposure to secondhand smoke;
  • and Because I believe everyone has the right to breathe clean air
I support smokefree public places and work sites to protect the health of all employees and patrons.
Name:
Salutation:
 First:
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 Last:
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Title:
Company:
Address:
Address 2:
City, State Zip: ,
Phone: () Ext:
Fax:
Your E-mail Address:

Yes. I am willing to help.

Attend Coalition Meetings
Display a yard sign or bumper sticker
Attend Public Forums or Hearings
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