Smoking Cessation Wellbeing Workshop - SMCP

Smoking Cessation Wellbeing Workshop Pre-interest Form

Sale Moor Community Centre, 271, Norris Road, Sale M33 2TN
We want to try and get an idea of attendance numbers and background information for our Smoking Cessation Wellbeing Workshops that we will be delivering in Trafford

Please note, all wellbeing workshops are free to attend and will last 2 hours. Light Meal will be provided at each workshop
Name:*
Postcode:*
Telephone:*
Email
example@example.com
UC - Universal CreditJSA - Job Seekers AllowanceESA - Employment & Support AllowanceDLA - Disability Living AllowancePIP - Personal Independent AllowanceAA - Attendance AllowanceNonePrefer not to say

Below are a list of venues where the workshops will taking place in East Manchester. Please select ONLY ONE venue you wish to attend*

Rows	Venue choices
1 - Sale Moor Community Centre: Sale Moor Community Centre: 193 Norris Rd, Sale M33 2TN

Date's for Sale Moor Community Centre. All Smoking Cessation Workshops are on the following Dates, 11am to 1pm:*
26/06/2516/07/2524/07/2514/08/2521/08/25

Rows	Yes	No
I am happy in appearing in photos or video footage
I am happy in providing a video testimony at the end of a workshop
I am happy with being a case study if needed

BMS Wellbeing CIC - Understanding you