Survey - ALASW Project Request: Programs - FY16 FFS Flyer & Email Sig - American Lung Association

ALASW Project Request: Programs - FY16 FFS Flyer & Email Sig

Effective 02/11/16: Request a Freedom From Smoking Facilitator Training Website as outlined on the ALASW Comm Dept Page; you need the website URL from that event to include as the answer to #4 (i.e. http://action.lung.org/FFS-AZ-091015) BEFORE you submit this form.

*1.

Question - Required - Training Date(s) & Time(s):

(Maximum response 255 chars, approx. 5 rows of text)

*2.

Question - Required - Name & Address of training location:

*3.

Question - Required - Local Staff Contact (name, phone & email):

*4.

Question - Required - What is your Register Online URL? (i.e. http://action.lung.org/FFS-AZ-091015)

5.

Question - Not Required - Any Additional Notes or Special Instructions? If you need to add images or other info, please upload to the server and paste the location here (i.e.: Use the "DMCCC Member Application 2015.pdf" in S:\Denver\Shared\PROGRAMS FOLDER\Clean Cities\Membership\2015 ). Do not send a separate email.

*6.

Question - Required - Due Date (5 business days lead time is requested)

Month

Day

Year

*7.

Question - Required - Name:

*8.

Question - Required - Email:

*9.

Question - Required - Phone:

*10.

Question - Required - Office:

*11.

Question - Required - Who is the Primary Decision Maker? (This person will receive all project updates. If final approval is received from this person, the design will be considered final and additional changes will require a new project request.)