Registration

• Conference fee includes all meals (2 lunches, 2 breakfasts and breaks) and materials.
• All cancelled registrations are subject to a $20.00 cancellation fee. No refunds given after November 10.
• There are a limited number of scholarships available. Contact Sarah Apple at sapple@uhs.wisc.edu or 608-265-8144 for more information.

Please complete information below:
Your Name:	First:   Last:
Organization:
Address:
City:
State:	Zip:
Email:
Phone:	( )  -
Fax:	( )  -
Do you have any special accommodation needs? If so, please describe below:
Program Selections
Select the breakout sessions you plan to attend. Refer to Breakout Sessions for descriptions. (Select one per timeslot)
SESSION 1
TUESDAY, NOVEMBER 18 (10:00 – 11:15 AM)
	Best Practices: Research to Application Keep Your Smoke Out of My Apartment! Enacting Smoke-Free Policies for Apartment Buildings – AND – Get It In Drive & Put It In Parks: Including Parks & Recreation Areas in the Tobacco Free Mix Smoking Cessation Medications: Review & in the Pipeline Wow What A Ride: Letting Youth Take the Drivers Seat & Enjoying the Ride Smokeless Tobacco: Growing Business, Sowing Harm The Many Faces of Disparities
SESSION 2
TUESDAY, NOVEMBER 18 (2:00 – 3:00 PM)
	Help—My Coalition Needs Resources! Wisconsin Tobacco Quit Line: Utilization, Evaluation & What's Ahead Bringing N-O-T Along: Addressing Disparities in Youth Tobacco Cessation Gearing up for 2009: Pedaling Our Legislative Priorities Using the 3 R's of Case Management in Treating Tobacco Dependence with LGBT Youth (3 R's - Reinforcement, Referrals, & Resources) Tobacco Free Campuses – Not Just for Healthcare
SESSION 3
WEDNESDAY, NOVEMBER 19 (8:15 – 9:30 AM)
	The Next Frontier: FDA Authority of Tobacco Killer Quotes! Using Tobacco Industry Documents to Create an Interactive Campaign – AND – Combining Media & Activism to Engage Youth Advocates Presenting Data to Influence Change Tobacco Cessation & the Poor: What Works? The Real Finish Line: Implementing Your Smoke-Free Ordinance Intergenerational Smoke Signals: American Indian Relationships with Tobacco, Research, & the People Around Us
SESSION 4
WEDNESDAY, NOVEMBER 19 (9:45 – 11:00 AM)
	Successful Coalition Building for Smoke-Free Air Tobacco & God: How does a Faith Based Approach Work? Reaching Tobacco Users with Psychiatric & Substance Use Disorders – AND – WiNTiP - Wisconsin's Plan for Integrating Tobacco Into Addiction & Mental Health Treatment Communication Power Tools: Get Attention! Persuade Action! Teen Tobacco Use in Wisconsin: New Trends & Factors that Influence Smoking 18-24 Year Olds: Tobacco Industry's New Target Market – AND – Using Peer Education & Outreach to Address Tobacco Use Among Students at UW-Milwaukee
Payment
Select method of payment:
	Check
	Purchase Order   PO#
	Code:
NOTE: For payments made by purchase order or check, an invoice will be sent to obtain payment.