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Last Updated 5-28-06


If the Registration form does not work for you, please send information in a regular email to Joan Davis at davisdh@siu.edu.

tobacco cessation button

Registration Form

Please complete the form below and send to Tobacco Free! Curriculum, formerly Leading the Way Helping our Patients to be Tobacco Free. You will be contacted after a review of your information. (The right to restrict access to this site is reserved.)

Name:

Title:

Status:
(Type in 'Educator')

Educational Institution:

Email Address:

Telephone Number:

Address:

Please enter any questions or comments you might have in the space below:




PROJECT SUPPORT
Tobacco Free! Curriculum© was developed by Joan M. Davis, RDH, MS, Assistant Professor, Dental Hygiene, School of Allied Health, College of Applied Science and Arts, Southern Illinois University—Carbondale, in fulfillment of the Tobacco-Cessation Curriculum-Development Fellowship awarded by the ADHA Institute for Oral Health and GlaxoSmithKline, Inc. in 2003. Indirect support was also provided by the Illinois Department of Public Health, the American Cancer Society, Illinois Division.

CONDITIONS OF USE
Tobacco Free! Curriculum © Davis 2004-2006 (formerly: Leading the Way, Helping our Patients to be Tobacco Free)

This modular educational program is intended for academic/classroom purposes only and is not to be used for continuing education programs or non-academic purposes.

Owners/developers of the images/original graphics contained in these modules have given their written permission for them to be used only in this training program, and they cannot be changed, stored, or used for any other purposes.

Please contact Joan M. Davis at davisdh@siu.edu or 618.453.8874 with any questions concerning use of this material.


Technical assistance and site design by S. Honey