Generation FREE Activity Team Report Organization Name*Team Name*Sponsor's Name* First Last Phone NumberEmail Address* Date of Activity* Shipping Address (No PO Boxes) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country County*AdamsAlcornAmiteAttalaBentonBolivarCalhounCarrollChickasawChoctawClaiborneClarkeClayCoahomaCopiahCovingtonDe SotoForrestFranklinGeorgeGreeneGrenadaHancockHarrisonHindsHolmesHumphreysIssaquenaItawambaJacksonJasperJeffersonJefferson DavisJonesKemperLafayetteLamarLauderdaleLawrenceLeakeLeeLefloreLincolnLowndesMadisonMarionMarshallMonroeMontgomeryNeshobaNewtonNoxubeeOktibbehaPanolaPearl RiverPerryPikePontotocPrentissQuitmanRankinScottSharkeySimpsonSmithStoneSunflowerTallahatchieTateTippahTishomingoTunicaUnionWalthallWarrenWashingtonWayneWebsterWilkinsonWinstonYalobushaYazooMTFC Director*Kathryn AllmanShatara AgnewTasha BaileyVickie BaileyHelen BoernerJacqueline CarterCassie ClintonRochelle CulpPaige DickeyKim HartRhonda HayesBeverly JohnsonBeverly KnoxKellie LambLeigh LamkinPamela Lang-PrestageWendy MageeSue MashburneStephanie MayfieldKeetha MoselyMelissa NashDesiree NorwoodJasmine PittmanJustin PopeYolanda PruittAnjanette RatliffMarcus RossMieshia SmithLinda TurnerCasey Ward-HamiltonPearl WattsTabitha WilsonSabrina WilsonMy MTFC isn't listedIf your MTFC isn't listed put their name here. If they are listed put N/ATitle of Activity*Activity Topic*AdvocacyBenefits of Being Tobacco FreeBenefits of Smoke-Free AirCessation ServicesCigar UseCommunication SkillsConflict ResolutionDangers of Tobacco UseDecision MakingEmerging ProductsGoal SettingHealth and WellnessKick Butts DayPoint of SalePromoting Smoke-Free OrdinancesRed Ribbon WeekRefusal SkillsSecondhand SmokeSelf- ImageSmoke-FreeSmokeless TobaccoTeam BuildingTobacco Industry ManipulationComments/SuggestionsDid media cover the event?YesNoWhich media outlets covered the event?# of FREE team members who participated in the activity*
