Freedom From Smoking Recertification Webcast Form

Thank you for your interest in becoming recertified as a Freedom From Smoking facilitator! While our team works to upload the on-demand recording of the live event to our training platform, we have created this form in the mean time to support those interested in viewing the webcast.

Upon completion of this form you will receive the link to the on-demand webcast, and the link to the Post-Webcast Evaluation. The steps to become recertified are as follows:

1. View the webcast in its entirety.
2. Complete the Post Evaluation and agree to the terms of the Facilitator Agreement Form.

With questions, email us at FreedomFromSmoking@Lung.org!

1. Name: *This question is required.

2. Email: *This question is required.

3. Organization: *This question is required.

4. Position Title: *This question is required.

5. Credentials:

6. Do you receive the Freedom From Smoking Facilitator Newsletter? *This question is required.

7. Within the past year have you facilitated a Freedom From Smoking group program (either virtually or in person)? *This question is required.