SIGN THE PLEDGE!LOOK AFTER YOUR FAMILY & WIN GREAT PRIZES!

Doing so will allow you to show support for your

team with a limited edition NRL - Deadly Choices

bumper sticker, plus you’ll be in the draw to win 4x

State of Origin Game 3 tickets plus limited edition

Deadly Maroons hoodies!

Fill out this form to take the pledge!

SIGN THE DEADLY PLACES, SMOKE-FREE SPACES PLEDGE TO LET EVERYONE KNOW YOUR CAR IS A DEADLY, SMOKE-FREE SPACE.

SIGN THE PLEDGE!Complete the below to take the pledge to make your car a deadly, Smoke-Free Space.

Name:

Phone number:

Email address:

Do you identify as:[ ] Aboriginal [ ] Torres Strait Islander[ ] Both [ ] Neither

Are you a:[ ] Current smoker [ ] Never smoked [ ] Ex-smoker less than 12mths [ ] Ex-smoker more than 12mths

Do you attend an Aboriginal Medical Service regularly?[ ] No [ ] Yes - which one?

How many people, including yourself, will benefit from you creating Smoke-Free Spaces? (How many people do you live with?)

By completing this pledge you’re committing to make your car smoke free.