End the sale of all flavored tobacco products - Endorsement form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

End the sale of all flavored tobacco products - Endorsement form - 2022

This form is for any individual or organization interested in endorsing the 2022 legislation to ban all tobacco flavors. If you have any questions or need additional information please contact Reilly Pharo Carter at reilly@rpcconsult.com / 303-919-7461.

Email *

Are you willing to endorse legislation to ban tobacco flavors? *

Yes, I want to be listed as a supporter of the state legislation for the end of all flavored tobacco products in Colorado. I approve my name, title and organization as listed below and have the authority to do so. I understand my name, organization and title may be published in materials supporting the tobacco flavor ban and that is may be used in a press release, in advertisements or during a media event.

Required

Endorser (please select one) // If you or someone from your organization is willing to be listed both individually as well as your organization, please fill out the form twice - once with individual information and once with organizational information. *

Individual

Organization

Required

Name as you wish for it to be publicly listed *

Name and Title *

Mailing Address

Phone Number *

Social Media (Twitter handle, Instagram name, Facebook, etc.) *

How would you like to to help support the legislation? Please select all that you are interested in and we will follow up accordingly. *

Be quoted in legislative materials

Volunteer / speak at events

Communicate / share updates with your employees or network

Place a link on your website

Write a letter to the editor

Write an opinion letter

Post on social media sites

Included on coalition emails and calls

Share action alert opportunities with our network

We have a lobbyist that can help advocate for the bill

Testify when the bill is in committee

Targeted outreach to key decision makers (ex: legislators, governor's office, etc.)

Other:

Required

Have you shared your logo with Tobacco Free Kids in the last few months? If no, I will follow up to get that from you. *

Yes

Not sure

What additional individuals or organizations would you recommend we reach out to and include in the coalition if they're interested? *

Any other information you would like to share? *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of rpcconsult.com.

Does this form look suspicious? Report

Forms