We are currently seeking participants for multiple research projects. Enter your contact information in the fields below, and we will add you to our recruiting list. Should we draw your name, we may call you to determine whether you are eligible to participate.

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Smoker?	Yes No
Smoke Amount:	(choose amount) I do not smoke 0-5 cigarettes per day 5-10 cigarettes per day 10-15 cigarettes per day 15-20 cigarettes per day 20-30 cigarettes per day 30-40 cigarettes per day 40+ cigarettes per day
Social Drinker?	Yes No
Drink Amount: (Standard alcoholic drinks per week)	One or less 2-5 5-10 10-15 15-20 20-30 30-40 40-50 50+