Registration

Register

Complete the information below to register in the program, request a Nicotine Replacement Therapy trial pack and join the First Week Challenge Contest.

First name*

Last name*

Email*

Gender*

Birthdate*

Province*

Postal code*

Do you identify as Indigenous?

Yes
No

Are you::

First Nations

Inuit

Métis

Indigenous

Username (visible in Forums)*

Password*

Password confirmation*

Password reset question*

Password reset answer*

Text Support

Receive quit smoking and vaping support on the go with text messages customized to your quit date, text KEYWORDS for extra help when needed, and text CHAT to chat live with a Quit Coach. This is a free service. You will not be charged text message fees.

Cell Phone*

If you register online, your first message will ask you to accept our terms of service via text.

NICODERM®/NICORETTE® trial offer

Register

Smokers’ Helpline and Talk Tobacco are pleased to offer a trial package of 2 NICODERM® patches and a sleeve of 15 pieces of NICORETTE® nicotine gum to qualifying quitters. For more information, click Details above.

You will need to provide us with the following additional information in order to register for this program.

Address*

City*

I confirm all of the following:

I am 18 years of age or over;
I am a daily smoker;
I am not pregnant or breast feeding;
I do not have a jaw disorder (such as temporomandibular joint disorder);
I do not have a generalized skin condition (e.g. hives, rash);
I am not allergic to nicotine nor have I had an allergic reaction to NICORETTE® or NICODERM®;
I have not ordered another NICODERM®/NICORETTE® Combination Therapy Trial Pack from Smokers' Helpline, Talk Tobacco or any other source after December 17, 2024; and
I assume any and all risk in connection with the use of the Combination Therapy Trial Offer and I release the Canadian Cancer Society from any and all liability which may arise from my use of the trial pack NRT

I give permission for my contact information to be shared with external partners for the purpose of mailing me my Combination Therapy Trial Pack and for following-up with me to get feedback regarding this trial pack program. I understand that my information will be kept secure and confidential and will only be used for the purpose of administering and evaluating this program.

Enter the First Week Challenge Contest

Quit smoking for the first 7 days of the month and you could win $500!

It's easy to get started: Enter now and remain tobacco free for the first week - the first 7 days - of next month, and you could win!

Yes, enter me in the challenge! By selecting yes to enter the Challenge, I acknowledge that I have read and agree to The First Week Challenge Contest rules.

Please provide a phone number where we can reach you if you are a potential winner:

I would like to receive emails about:

News & Announcements
Evaluation & Feedback

* I agree to the Terms of Use

Privacy Disclosure

We collect your personal information here or as set out in more detail in the SmokerHelpline Privacy Statement to manage your participation in the program, inform you about other services and contact you to provide updates about our impact and ways to support us or give. We may also use your information for program evaluation and quality assurance. We may share your personal information with third parties including service providers, consultants and advisors outside your province or territory or outside of Canada only to carry out the purposes identified above, or as required by law. We may contact you by mail, email, phone or text. You can exercise your right to access your information or have it corrected, unsubscribe from communications or withdraw your consent by calling 1-888-939-3333 or emailing privacy@cancer.ca. For more information about our privacy practices, visit cancer.ca/privacy