Contest

Contest Registration Form

1. Contest Category:

   Quit 4 Good Keep The Count Party Without the Smoke Don’t Start & Win

2. First name:
   Last name:

3. Phone (1):	- ext.
   Phone (2):	- ext.

4. Email Address:
   Confirm Email Address:

5. Gender:

   Female

   Male

   Other

6. Age:

7. What school do you attend?:

   Algoma University Algonquin College Boreal College Brock University Cambrian College Canadore College Carleton University Centennial College Conestoga College Confederation College Durham College Fanshawe College Fleming College: Frost Fleming College: Sutherland George Brown College: Casa Loma George Brown College: St. James Georgian College Humber College: Lakeshore Humber College: North La Cité collégiale Lakehead University: Main Lakehead University: Orillia Lambton College Laurentian University Loyalist College McMaster University Mohawk College Niagara College: NOTL Niagara College: Welland Nipissing University Northern College Ontario College of Art & Design Queen's University Ryerson University Sault College Seneca College Sheridan College: Davis Sheridan College: Trafalgar Road St. Clair College: Chatham St. Clair College: Windsor St. Lawrence College Trent University University of Guelph University of Ontario Institute of Technology University of Ottawa University of Toronto: Mississauga University of Toronto: Scarborough University of Toronto: St. George University of Waterloo University of Western Ontario University of Windsor Wilfrid Laurier University: Brantford Wilfrid Laurier University: Main York University: Glendon York University: Keele Other

   If other, please specifiy:

8. Student ID number:

Your Buddy Info

9. First name:
   Last name:

10. Email Address:
    Confirm Email Address:

11. Does your buddy smoke?

    Yes

    No

12. Is your buddy also registered as a contestant in the wouldurather... contest?

    Yes

    No