Texas Youth Tobacco Awareness Program Class Schedule 

Limited space available, register online now. Class  dates:  

02/2112,  02/23/12, 02/28/12 and 03/01/12

Tues/Thurs.6:00pm - 8:00pm

1705 Continental Pass

Cedar Park, Texas, 78613    

PH# 512-986-5662 or 512-913-5561

TEXT: tobacco to 69302

Tuition: $65.00 Paypal, Cash, Money Order - NO CHECKS.

GO TO BOTTOM OF PAGE TO PAY BY PAYPAL

YOUR PAID TUITION GUARANTEES YOU A SEAT IN CLASS

OR PAY AT CLASS NO CHECKS.

Registration Form


________Adolescent Tobacco Cessation (8 hours)                        $65.00



DATES OF THE CLASS YOU WISH TO TAKE: __________________________________

Name___________________________________________  Age __________________

DL or SS#______________________________________ DOB____________________

Street Address___________________________________________________________

City, State, Zip Code_______________________________________________________

Phone number(s)_________________________________________________________

Parent’s Signature, if you are under 16________________________________________

Who referred you? Please state specific court, judge, or probation officer,

if referred for legal reasons  _______________________________________________

Payment Options _______________________________________________________

Email Address __________________________________________________________

Signature _____________________________________________________________

Please print registration and email or bring to class.

Text: tobacco to 69302

E-mail josephihenry@josephihenry.com

Fax: 512-428-8162

Tuition: $65.00

65.00