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Basic Membership Registration

Registration Information


	Title:
*	First Name: Required
	Middle Name:
*	Last Name: Required
	Suffix:
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
	Country:
	Yes, I would like to receive e-mail from American Lung Association
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Please enter a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

*	User Name: Required	5 to 60 characters
*	Password: Required	5 to 20 characters
*	Repeat Password: Required

For your password above, please select a combination of letters and numbers, only. No spaces, special characters or symbols.

Question - Not Required - Quit Date: enter the date you are targeting to quit smoking by (optional).

Month

Day

Year

Question - Not Required - Group (Leave this area blank if you do not know):

Terms of Service for FFS Online

The American Lung Association’s Freedom From Smoking (FFS) Online program provides health information but should not be considered medical advice. FFS Online participants should consult their doctor or other health care provider for a professional medical opinion.
Access to the American Lung Association’s FFS Online Community and Message Boards is reserved for individuals with Premium membership. The purpose of the FFS Online Community is for participants to give and receive support online as they progress through the Modules.
Inappropriate or offensive posts will not be tolerated. Any inflammatory post reported to the American Lung Association will be reviewed and possibly censored. If the offensive posts continue, the American Lung Association reserves the right to deactivate a participant’s FFS Online account.
Premium membership for FFS Online costs $15.00 for three months or $40.00 for one year. Members will be contacted via email at the end of their membership term with an option to renew.
Members may cancel at anytime, but refunds will not be issued after seven days of signing up for Freedom From Smoking Online.
If a member is not satisfied with his/her membership for any reason, the membership may be cancelled within seven days of initial registration. A full refund will be granted upon request (issued as a credit to the billing account on record), provided that the member requests the refund before seven days has passed.