Take the Smoke-Free Home Pledge!

I, *, on *, * pledge to protect myself and others from the health risks of secondhand smoke by keeping my home smoke-free.
Before now, was smoking allowed in your home (by family or visitors)?

Do you have children under the age of 18 living in the home?

Would you like a Smoke-free Home Kit mailed to you? (if yes, please fill out your mailing address below)

Name:
Address:
City: State: Zip Code:

     I live in a(n)* Single family house | Apartment | Condo | Co-op | Townhouse | Mobile Home |
Other
If you live in an apartment, other multi-unit building, or other rental unit, does your building have a written smoke-free policy?

*Required fields


Copyright © 2010 Smoke-Free Housing Coalition of Maine