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Step 1 of 6

Thank you for registering for an account. Please choose the type of access:

Occupation*

Other:

Name*

First Last

Phone*

Phone Ext. (if applicable)

Workplace/Health Institution*

Region*

Unit/Program

If referring from Hospital, please specify

Username*

Please choose a username which will be visible in Chat Forums/Message Boards on this site.

Email*

We will protect your privacy and your email address will not be shared with anyone.

Create a password to log-in to this site.*

Enter Password Confirm Password

The Helpline is pleased to provide you with feedback reports/updates several times per year regarding best practices in the area of tobacco cessation. How would you prefer to receive communications from the Smokers' Helpline?

Fax

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