Every ex-smoker has a story about how they were finally able to quit for good. And, now you can use your story to help others quit. Because people need to know that they are not alone and that others have faced the same challenges and succeeded. So, if you'd like to help others quit smoking for good, please fill out the form below and tell us your story.

Step 1 - Fill out the form below and hit the 'Next' button once completed.

Public (This information will appear on your story)

First Name

Last Name

Check here if you don't want your name to appear with your story.

City

State

Age

Quit for (years, months)

Story

Select an image to appear with your story.

Image

To add a video to your story, copy and paste the url of your YouTube video into the below field.

YouTube Video URL

Please note that you can have either a video or a photo appear with your story. If you have added both the video will appear by default.

Private (This information will not be shared)

Phone

Password

Share things you've learned about quitting and almost quitting.