Smoke-free Dining Guide Order Form
If you are a 100% Smoke-free restaurant owner or manager and would like to order free copies of the Central Iowa Smoke-free Dining Guide so that you can distribute these helpful materials to your customers, please use the order form below. Thank you for helping us promote Smoke-free dining! 

 

Basic Information:
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Restaurant Name:
Owner / Manager:
Restaurant Address:
City:
State / Zip: /
Restaurant Phone #:


Number of Copies Requested:
Central Iowa Smoke-free Dining Guide:

Additional Comments: