Thank you for your interest in taking part in an interview to talk about a smoking cessation campaign in Norfolk. Please use this below form to submit your information and sign-up to take part.
Please note that your information will only be used for the purpose of contacting you about this project to take part in research. For more information on how we store and process data, please see our GDPR Policy here: https://social-change.co.uk/files/20.12.22_SC_Privacy_Policy_.pdf
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1. Do you consent to sharing your information and being contacted to take part in this project? *
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2. Do you currently smoke? *
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4. Do you have a partner or family member who is pregnant?
5. If you have a partner/family member who is pregnant, do they smoke?
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7. What is your gender? *
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8. What is your postcode? E.g., AB1 D23 *
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9. Please provide the below details so we can contact you about this project. *