URGENT NOTICE TO ALL EMPLOYEES!
PLEASE READ THIS AND RESPOND PROMPTLY

Our Company has been selected to participate in a very exciting new program. 

This program will include ONLY those of you or your immediate family who smoke or use smokeless tobacco and have a sincere desire to QUIT. 

A twenty-year old company specializing in health research has developed a stop smoking program that is so effective, nearly EVERYONE who uses it stops smoking in just a few days! During the ten year development phase HUNDREDS OF THOUSANDS of people around the world successfully stopped smoking or using smokeless tobacco with this program after numerous unsuccessful attempts using traditional products and methods!

If you and / or a family member would like to participate in this exciting program, please complete the enclosed questionnaire and return it to the office of Human Resources within seven days.

We are concerned about the health of our employees and their loved ones and we are committed to helping those who want help in breaking their nicotine habit.


Cigarettes are the NUMBER ONE CAUSE OF PREVENTABLE DEATH in the U.S., killing more people each year than AIDS, ALCOHOL, DRUG ABUSE, CAR ACCIDENTS, HOMICIDES, SUICIDES AND FIRES COMBINED! One in every three smokers DIES from a smoking related disease!


























EMPLOYEE SURVEY

If you or a family member smokes cigarettes or uses smokeless tobacco and would like to quit, please complete this form and return to the office of Human Resources.

1. I have been smoking for __________ years.

2. I smoke ___________ pack(s) of cigarettes per day.

3. List three important reasons that you would like to quit:
A. _______________________________________________________
B. _______________________________________________________
C. _______________________________________________________


4. When would you like to quit smoking? (Check one)
_____ A. Within the next year.
_____ B. Within the next six months.
_____ C. Within the next 30 days
_____ D. Immediately

5. On a scale of one to ten, rate your desire to quit smoking; one being little desire to quit, and ten being most urgent or greatest desire. _________

6. How many times have you tried to quit in the past? _____________times.

At current prices, the average smoker will now spend $1500. to $2000. per year on cigarettes.

7. What would you like to do with the money you will save on cigarettes? 

_______________________________________________________________

8. Who do you dedicate this special event of quitting to? __________________

Your Name: ________________________________________________

Home Street Address: _______________________________________

City, State, ZIP: ____________________________________________

Home Phone: ______________________________________________

Today's Date: ______________________________________________

E-mail Address: ______________________________________________

All information above is strictly confidential and will not be sold or distributed.