Contest

Contest Registration Form

All fields are mandatory unless indicated otherwise.

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. (optional)

4. Email Address:
   Confirm Email Address:
   Alternate Email Address:	(optional)

5. Gender:

   Female

   Male

   Other

6. Age:

7. What school do you attend?:

   Please select your campusAlgoma CollegeAlgonquin CollegeCollege BorealBrock UniversityCambrian CollegeCanadore CollegeCarleton UniversityCentennial CollegeConestoga CollegeConfederation CollegeDurham CollegeFleming College: PeterboroughFleming College: LindsayFanshawe CollegeGeorge Brown CollegeGeorgian CollegeGuelph UniversityHumber College (south)Humber College (north)La Cite CollegeLakehead University: ThunderbayLakehead University: OrilliaLambton CollegeLaurentian UniversityLoyalist CollegeMcMaster UniversityMohawk CollegeNiagara College: NOTLNiagara College: WellandNipissing UniversityNorthern CollegeUOITOCAD UniversityOttawa UniversityQueen’s UniversityRyerson UniversitySault CollegeSeneca College: NewnhamSeneca College: YorkSheridan College: TrafalgarSheridan College: HMCSheridan College: DavisSt. Clair College: WindsorSt. Clair College: ChathamSt. Lawrence CollegeTrent UniversityUniversity of Toronto: St. GeorgeUniversity of Toronto: ScarboroughUniversity of Toronto: MississaugaUniversity of WindsorWaterloo UniversityWestern UniversityWilfrid Laurier University: WaterlooWilfrid Laurier University: BrantfordYork University: KeeleYork University: GlendonOther

   If other, please specifiy:

8. Student ID number: