Break It Off from Smoking First Name*Last Name*Email* PhoneAge*--18192021222324252627282930+*If you are outside the 18-29 age requirement for this contest, don’t worry. You can still take advantage of contest tools and resources; you just won’t be eligible for the cash prize.Province*--AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonSmoking Status*--Non-smokerPast smokerOccasional smokerSocial smokerDaily smokerHow did you find us?*--SchoolFacebookInstagramWebsiteFriend or family member"Refer and Support a Friend" challengeOther* I understand and agree to the official contest rules & regulations entry dateBy entering the Ultimate Break It Off Contest you’ve opted in to receive emails from the Break It Off campaign. You can unsubscribe at any time. EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.