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Quitober questionnaire for smokers:
Actual registration for Quitober will be available in August 09.
Please tell us what you think of the
Quitober 09 (see more)
& if you and your employer would be interested in participating in 09.
Privacy statement
Your Name :
Email :
Company/Employer/Uni/College :
Post Code :
Q1: Would you participate in Quitober 09?
Yes           No        Maybe
Q2. Approx. number of smokes per day? :
Q3. Your Age? :
Q4. Male or female? :
Male                            Female
Q1. Would you get sponsored by a Group Sponsor
(eg. employer) or an Individual Sponsor (friend)?
Single       Group       Not Interested
Q6: How many times have you tried to Quit in 2008?:
Q7: Is your partner a smoker?:
Yes           No                       Don't have one
Q8: Would you be willing to pay $31 to become a member of Quitober 09?
($1 per day during October- Students $15.50 ie. 50c per day)
Yes           No          Maybe        
Q9: Could you get your employer friends or family to sponsor you? Your sponsor pays for your membership if you succeed quitting for the month.
Yes           No          Maybe Don't know
Q10: How many of your work/Uni mates smoke?:
Q11:Do you think your work/Uni mates would
participate in Quitober?:
Yes           No          Maybe Don't know
Q12: If you were going to Quit would you use NRT ie. nicotine patches and/or gum?
Yes           No                               Don't know
Any further other comments & feedback:

What some people think of the idea
Yahoo - Answers
Flying Solo Forum



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