Membership Application
This page reproduces material published by the Tobacco Cessation Leadership Network between 2005 and 2008. Names, roles, partners and funders are as published at that time and do not describe any current relationship, endorsement or funding. Nothing here is medical advice.
This page records the membership application the Network published for state and national cessation leaders. The application is reproduced as a record; it is no longer accepting submissions.
Information the application collected
- First name, middle initial and last name
- Degrees
- Current place of employment
- Address and delivery address
- City, state and ZIP code
- Office phone, extension and fax
- Office email
- Affiliation
Interest areas
Applicants marked one or more interest areas, and separately marked the same list as areas of expertise.
- Developing and Implementing Comprehensive Approaches
- Reaching Employers and Purchasers
- Health Care System Initiatives
- Tools and Resources for Health Professionals
- How to Quit Resources for Tobacco Users
- Medicare and Medicaid Initiatives
- Policy Development
- Quitline Operations, Research and Development
- Reaching Special/Priority Populations
- Training of Health Professionals
Participation statements
- I agree to collaborate in the sharing of information and resources, especially regarding implementation of cessation programs and initiatives, whenever possible.
- I agree to have my contact information posted on the TCLN membership directory.
Return address as published
Oregon Health & Science University, Smoking Cessation Center, 3181 SW Sam Jackson Park Rd, CR115, Portland, OR 97239. Fax: 503-494-5407.
Published 2006 · Reviewed 10 August 2026