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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country County*AdamsAlcornAmiteAttalaBentonBolivarCalhounCarrollChickasawChoctawClaiborneClarkeClayCoahomaCopiahCovingtonDe SotoForrestFranklinGeorgeGreeneGrenadaHancockHarrisonHindsHolmesHumphreysIssaquenaItawambaJacksonJasperJeffersonJefferson DavisJonesKemperLafayetteLamarLauderdaleLawrenceLeakeLeeLefloreLincolnLowndesMadisonMarionMarshallMonroeMontgomeryNeshobaNewtonNoxubeeOktibbehaPanolaPearl RiverPerryPikePontotocPrentissQuitmanRankinScottSharkeySimpsonSmithStoneSunflowerTallahatchieTateTippahTishomingoTunicaUnionWalthallWarrenWashingtonWayneWebsterWilkinsonWinstonYalobushaYazooMTFC Director*Shatara 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 WilsonTitle 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*
