World Smokefree May 2025 (1) Mass quit campaign sign up form Name(Required) First Last Email(Required) Phone(Required)Region(Required)Select regionTe Tai Tokerau NorthlandTāmaki Makaurau AucklandWaikatoBay of PlentyTairāwhiti GisborneTaranaki, Whanganui, Palmerston NorthNapierWellingtonTe Tau Ihu - Nelson and MarlboroughWest CoastCanterburySouth CanterburyOtago/SouthlandSelect Otago/Southland Region(Required)Select regionNorth OtagoOtago & South OtagoCentral OtagoQueenstownSouthlandDate of Birth(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required) Male Female Prefer not to say Other Ethnicity(Required) Māori Samoan Tongan Cook Island Māori Niuean Tuvaluan Fijian NZ European/Pākehā Chinese Japanese Filipino Indian Korean Other How long have you been smoking?(Required) Less than a year 1-5 years 6-10 years 10+ years Other ethnicity(Required)Are you pregnant?(Required) Yes No Do you live with someone who is pregnant?(Required) Yes No Would you like support from your local stop smoking service?(Required)Connecting with your local Stop Smoking Service will allow you to access free NRT (Nicotine Replacement Therapy) and a personalised quit plan that will give you the best chance possible to succeed.SelectYesNoFind a stop smoking service in your region. To learn more about stop smoking services in your region visit our stop smoking services database. * By selecting a stop smoking service you agree that your contact details will be passed along to your preferred service.Stop smoking services - Te Tai Tokerau Northland(Required)Select a stop smoking service in your region. Toki Rau Stop Smoking Services Northland Stop smoking services - Tāmaki Makaurau Auckland(Required)Select a stop smoking service in your region. Ready, Steady, Quit - North, East, West and Central; Auckland only The Fono Stop Smoking Service Te Ara Tika Quit Smoking - Turuki Healthcare Counties Manukau Living Smokefree Service Stop smoking services - Waikato(Required)Select a stop smoking service in your region. Manaaki Ora Smokefree Support Service - Taupō, Turangi and Mangakino only Kaute Pasifika - Pacific Smokefree Services Once and For All Stop Smoking Service Stop smoking services - Bay of Plenty(Required)Select a stop smoking service in your region. Hāpainga Stop Smoking Service - Eastern & Western Bay of Plenty Manaaki Ora Smokefree Support Service (Rotorua) Stop smoking services - Tairāwhiti Gisborne(Required)Select a stop smoking service in your region. Turanga Health Stop smoking services - Taranaki, Whanganui, Palmerston North(Required)Select a stop smoking service in your region. Tui Ora - Taranaki Stop Smoking Service Ngā Taura Tūhono - Whanganui Stop Smoking Service Te Ohu Auahi Mutunga - Levin Stop smoking services - Hawke's Bay(Required)Select a stop smoking service in your region. Te Haa Matea Stop Smoking Service Te Kupenga Hauora - Ahuriri Te Taiwhenua o Heretaunga Choices Kahungunu Health Stop smoking services - Wellington(Required)Select a stop smoking service in your region. Takiri Mai Te Ata Regional Stop Smoking Service Whai Ora Wairarapa Stop Smoking Service Pacific Health Plus Porirua Stop Smoking Service Stop smoking services - Te Tau Ihu - Nelson and Marlborough(Required)Select a stop smoking service in your region. Nelson Marlborough Stop Smoking Service Te Hā - Te Piki Oranga Stop smoking services - West Coast(Required)Select a stop smoking service in your region. Oranga Hā - Tai Poutini: Stop Smoking West Coast (mobile service) - Westport Oranga Hā - Tai Poutini: Stop Smoking West Coast (mobile service) - Greymouth Coast Quit Stop smoking services - Canterbury(Required)Select a stop smoking service in your region. Te Hā Waitaha Smokefree Support Tangata Atumotu Trust Stop smoking services - South Canterbury(Required)Select a stop smoking service in your region. Arowhenua Whānau Service (South Canterbury Stop Smoking Service) Stop smoking services - Otago/Southland(Required)Select a stop smoking service in your region. Southern Stop Smoking Service (mobile service for Otago and Southland) - Queenstown, Alexandra, Invercargill, and Dunedin Share your WHY with us - What is your reason for wanting to Quit? (Required)Terms & Privacy:(Required) I agree to the Terms and Conditions and Privacy Policy.Terms and Conditions, Privacy PolicyJoin the Tobacco Control Update Newsletter Yes, please keep me up to date with the latest tobacco control news. Stop Smoking Services
