American Lung Association of Oregon

Information Request Form

Complete this form to receive information as requested. Your personal information will be kept strictly confidential. Please refer to our privacy policy for details.

1) Submit Contact Information:

First Name:		Last Name:
Address:
City:		State:
Zip:
Email:		Phone:

2) Choose Topics:

Check the boxes next to the topics you're interested in. Information requested will be sent within two weeks of the submission of this form.

Asthma Programs

	Asthma		Asthma Camp Partnership Program
	Open Airways for Schools		Exercise & Asthma

Air Quality

	Tools for Schools		Indoor Air Quality
	Outdoor Air Quality		Advocating for Clean Air

Lung Disease

	Better Breathers Support Groups		COPD
	Emphysema		Bronchitis
	Referrals for assistance with medications

Tobacco Prevention

	Youth Tobacco Cessation		Adult Tobacco Cessation
	Fresh Air For Little Noses

Research & Professional

	Graduate Nursing Scholarships		Young Investigators Research Grants
	Oregon Thoracic Society		Chest Disease Conference

Planned Giving

	Bequests		Annuities
	Trusts		Memorials

Events

	Reach the Beach			Reach the Summit
	Reach The Bridge			Asthma Educator Institute
	Asthma in Action Award

Volunteering

	General Office		Fresh Air For Little Noses
	Tobacco Prevention		Asthma
	Reach the Beach

Other Requests or Comments

Please add me to the Breathing in Oregon mailing list. BIO is a free, quarterly newsletter of the American Lung Association of Oregon.

Please have an American Lung Association of Oregon staff member contact me by phone.

If you have further questions, please contact info@lungoregon.org or call 503-924-4094.