Working for Oldbury, Smethwick, Wednesbury, West Bomwich, Rowley Regis & Tipton

Mobile Unit Booking Form

Contact Name:

Job title :

Email address:

Organisation Name:

Address of
organisation :

Telephone No:

Mobile No :

Fax:

Date(s) requested :

Type of event, target audience and reason for a mobile unit.*
(Please give as much detail as possible):

Time of event:

Duration of event:

Location of Event (if different to organisation address)

Representatives who will be present on the day:

Aim and purpose of the event :

Any materials / resources:

Any additional information:

Alternatively you can contact us at:

Sandwell Stop Smoking Service
Victoria House, 2nd Floor, 290-292 High Street,
West Bromwich, West Midlands, B70 8EN

Email: Maxine.Stephenson@sandwell-pct.nhs.uk
We are open Monday - Friday 9am to 4:30pm

Did You Know?

Smoking is the UK's single greatest cause of preventable illness and death.

More than 120,000 people in the UK die from smoking each year.

70% of smokers say they want to give up.

British Heart Foundation, 2004

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