Registration

2018 Quit and Win Competition Registration Form
Participant (Smoker)
A. Personal Details:
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B. Smoking Habits:
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C. Declaration
I am willing to abide by all rules of this competition and stop smoking from October 1st to October 28th 2018
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Support Person (Non-Smoker)
A. Personal Details
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Declaration
I am a non-smoker or an ex-smoker who hasn’t smoked for over 1 year. I agree to support, encourage and witness the participant who will stop smoking from Monday 3 October 2018 to Sunday 28 October 2018.
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2018 Quit and Win Competition Declaration
Participant
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I have abided by all rules of this campaign, and I have not smoked between 3 October 2018 and 28 October 2018.

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Support Person
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I have supported, encouraged and witnessed the participant between 3 October 2018 and 28 October 2018. I declare they have not smoked during this time. I understand that a false declaration will result in disqualification for both the participant and support person.

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