Cleveland Clean Indoor Air Campaign
1226 Huron Rd., STE 300, Cleveland, OH 44115 · www.smokefreeohio.org
In order to
Protect families and workers from secondhand smoke,
I endorse Clean Indoor Air in Cleveland.
I allow my name to be used in support of Clean Indoor Air in the City of Cleveland (i.e. My
name may be used in newspaper articles and advertisements and given to local elected officials).
This information will be used solely for tobacco prevention efforts and will not be sold or used
for solicitation.
Name: Date:
(Please print)
E-mail:
Mailing Address:
City: State: Zip:
Phone: Fax:
YES! I want to help by:
Collecting endorsements
Attending forums, community events or public hearings
Distributing information in my neighborhood
Other: __________________________________________________________
Please write additional comments concerning your feelings on this issue. Note: If you live in
a Cleveland suburb or are not a resident of the City of Cleveland, please also briefly describe
why you visit Cleveland (e.g. Work, entertainment, etc.):
Register online and keep updated at www.smokefreeohio.org
Please return this form to: For more information, contact:
Cleveland Clean Indoor Air Campaign Adam Grauer, Coordinator
1226 Huron Rd., STE 300 216-781-2944 ext.413
Cleveland, OH 44115 agrauer@fcp.org
Fax: 216-781-2988