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Teen Smoking – SR

Teen Smoking – SR

Teen Smoking

If you are a human and are seeing this field, please leave it blank.

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Is your child between the ages of 12 to 16?

Yes
No

Does your child smoke cigarettes?

Yes
No

Does your child smoke cigarettes every day?

Yes
No

Fill out the form below and you will be contacted by a representative if you qualify.

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip / Post Code *

Country *

Gender

Male
Female

Birth Date

Email *

Phone *

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* In a clinical research study, the participants may receive investigational study product or may receive an inactive substance, or placebo, depending on the study design. Participants receive study-related care from a doctor/research team for the duration of the study. Reasonable payments will be made for participation and the length of the study may vary.