Win FREE Tickets to Alabama vs. Fresno State

Have you ever been prescribed Zantac by a doctor?*

In addition to taking prescription Zantac, have you ever taken non-prescription Zantac that you purchased off the shelf?*

Have you ever taken Zantac over an extended period of time (60+ days)?*

Have you ever been medically-diagnosed with any of these cancers?*

Name*

First Last

Email*

Phone*

Phone

This field is for validation purposes and should be left unchanged.

Win FREE Tickets to an Alabama Game This Season!