Join the Together Programme

Step 1: Personal details

* Title

* Forename

* Surname

* Email Address

* Quit Date

Day Month Year

NB. This must be between 4 days and 2 months after your Together registration.

* Address 1

Address 2

* City

* Postcode

* Country

England - If you live in Scotland, Wales or Northern Ireland please click here

* Contact Phone

* How did you hear about the Together programme?

Step 2: A little more about you

* Date of Birth

Day Month Year

* Gender

Female Male

On average how many cigarettes do you smoke a day?

How long have you been a smoker?

What is your primary reason for your decision to want to give up smoking?

How many times have you tried to give up before?

Step 3: Staying in touch

For us to be with you every step of the way, we need your consent. Please tick the applicable boxes below to indicate that you are happy to be contacted by post, email, text and phone.

I agree to receive programme material *

Can we contact you by post? *

Can we contact you by telephone?

Can we contact you by text (SMS)?

Mobile Phone

Can we contact you by email?

Did you know...

If you attend group sessions and/or use patches, gum or other aids, you are FOUR times more likely to succeed at going Smokefree than going it alone.

Call the smoking helpline:
0800 022 4 332 NOW!