Registration Form

List name, age, grade, and births of children in C.A.S.S. and AYAC.

Only 5 To Save Lives Overview


Parents Against Secondhand Smoke
Registration Fee (1yr)
P.A.S.S. are Parents taking a stand to protect their children (born/unborn) from Secondhand Smoke
They are ‘passing on’ the knowledge of the dangers & facts.
Meet once a month through teleconference, Google Hangout, and (Brunch & Learn) to get relevant information on Secondhand Smoke
They will enroll their children in ‘The C.A.S.S. Member’ program

per child per month
Children Against Secondhand Smoke
Ages: 0-Elementary
The C.A.S.S. Members are children who are The Next Generation of Non-Smokers.
They are Pre-School to Elementary age children who, through the efforts of A.C.C.E.S.S., will recognize the dangers of SS and are taking charge of their future health with the help of their parents.

C.A.S.S. Child

per youth per month
ACCESS' Youth In Action Crew
Ages: Middle School-High School
A.C.C.E.S.S.’ Youth in Action Crew represent youth ages Middle School & up.
They will advise us from the youth perspective in spreading awareness especially regarding e-cigarettes
They will play a major role in designing our A.C.C.E.S.S. line of Clothing
And will receive mentoring/life skills and more

AYAC Youth

per month
Friends Of A.C.C.E.S.S.
Choice of $25, $50, $75, $125 or other. Click "Subscribe" for more options.
Open to individuals who may or may not have children
Open to those who believe in our cause and want to support it
Our Friends play a vital role in helping to share the Mission, Purpose, and Goals of A.C.C.E.S.S.
They are the passionate faces & voices that keep the vision going

FOA Option