IQuit

To begin, let us get to you know better. The form will take just 3 min to complete.

Personal Information

Full Name *

NRIC/FIN *

Gender *

Male

Female

Race *

Year of Birth *

Mobile No *

+65

Email *

Postal Code

Supporter Information

Nominated Supporter Name

Nominated Supporter Mobile

+65

Nominated Supporter Language Preference For SMS

English (Default)

Chinese

Malay

Sign-up Information

Which roadshow or location are you signing up from? *

I agree with the I Quit Terms & Conditions and Privacy Policy.

By signing up for the I Quit 28-Day Countdown, you agree and consent for your information to be used for the planning of Health Promotion Board's programmes and also with other relevant government agencies to bring you better healthcare options. Your data will be stored and transmitted with appropriate security technologies.

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