Request for additional resources

If you require additional resouces from the Manchester Stop Smoking Service (subject to availability and demand) please fill in the following form. (Fields marked with a * have to be filled in)

Contact name *
Organisation *
Address *
Postcode *  
Contact number 
Email address
Please send me additional (please select as appropriate)
Resource  
Quantity
        
Beer mats


   
Leaflets
 
Wristbands      
Posters