Health-Smart Behavior Program Tools Interest Form Thank you for your interest in the Health-Smart Behavior Program tools developed by Dr. Carolyn M. Tucker and her research team. Please complete the form below and you will be contacted by a research team member. Name*PrefixFirstLastSuffixOrganization Mailing Address*Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP CodePhone NumberEmail*Enter EmailConfirm EmailPlease select the Health-Smart Behavior Program tools you are interested in. (Check all that apply)Family Health Self-Empowerment DVD – English VersionFamily Health Self-Empowerment DVD – Spanish VersionHealth-Smart Behavior Resource Guide – English VersionHealth-Smart Behavior Resource Guide – Spanish VersionHealth-Smart Behavior Program Training & Implementation ManualComments: