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Smokers > Options for Quitting Smoking
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Current Smokers Sought to Test New Nicotine Vaccine

The University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) is recruiting smokers in Madison and surrounding communities to participate in a new nicotine-vaccine research study.

    • Participants will be asked to make up to 20 clinic visits over the course of a year. Participants will receive compensation to cover the time and transportation for the clinic visits.

    • Please read all of these instructions before completing the form.

    • We need at least one phone number to contact you.

    • The two “how heard” fields help us determine how best to recruit participants for future important health research.

    • All of this information remains confidential. We do not share this information with any other individuals or organization.
  • It may be a few weeks before you hear from us. Thank you for your patience!

Your full name

A daytime phone number (including the area code)

An evening phone number (including the area code)

A cell phone number
(including the area code)

The best times to reach you

Your E-mail Address

How you heard about us

If it was on TV, radio or in the newspaper, please let us know what station or what paper
OR if you chose 'Other',
specify here.

Your City

Your Zip Code

Due to high interest in this study, space is limited. If you cannot participate in this study, would you be interested in hearing about other studies to help you quit smoking?

Yes     No, thanks
     

Thank you for your interest and we look forward to speaking with you!

© 2009 UW-CTRI