The Campaign for Tobacco-Free Kids (CTFK) has a strict policy of not in any way materially supporting or providing services to anyone with direct ties to the tobacco industry and requires that all Forum Members declare their relationship(s), direct or indirect, if any, to the industry.

1. Because of the above, I warrant I do not knowingly:

• Whether paid or not represent, consult for, work for, or conduct research for, or receive funding or support from any member of the tobacco industry including, but not limited to, any tobacco product manufacturers, wholesalers or importers; any parent, affiliate or subsidiary company (including subsidiaries not involved in tobacco work) of any tobacco product manufacturers, wholesalers or importers; any interest group, advocacy group, law firm, advertising agency, public relations firm, or other organization or business that represents the interests of the tobacco industry or any of its members, and I have not done so for at least two years;
• Nor do I work for any organization that receives any funding or support from any member of the tobacco industry or has any member of the tobacco industry as a client, and I have not done so for at least two years.

I further warrant that I do not directly own more than 10 shares of stock or have any direct ownership interest beyond 10 shares in any tobacco product manufacturer, wholesaler, or importer (except share holdings through general mutual funds or similar arrangements where I do not have control over the selection of shares), and I have not done so for at least two years.

I agree that should I enter into any such agreements or relationships with any of the entities listed above, I immediately will notify The Forum Administration Committee at lawyersforum@tfk.org and will amend my Declaration Regarding Tobacco Industry Relationships accordingly.

I further agree that I will not share or otherwise disclose the contents of any materials or work product available on the Forum site with any member of the tobacco industry, as described in item 1.

I further acknowledge that if I knowingly fail to make any of the disclosures and updates required by item 3, above; knowingly provide inaccurate information in response to any of the above items; knowingly enter into a new relationship with any member of the tobacco industry, as described in item 1 without prior notice to the Forum Administration Committee; or share or disclose the contents of any Forum materials or work product as described in item 4, I will be immediately removed from Forum membership, and I hereby provide the Forum and its Administration Committee with full authority to announce any such removal from the Forum membership publicly and to other members and to provide the reasons for that removal.

If you checked “B” in Declaration 1 or 2 above, or have any other relationship to the tobacco industry not captured in Declarations 1 or 2, please state the nature of the relationship in the box below.