Tobacco Waiver Request

Name *

First

Last

Work Email *

Job Title *

Organization *

Organization Website *

Organization Type

• 501(c)(3) Public Health Advocacy Organization
• Academic
• Other (describe below)

If other, please describe

Please describe your role and your organization's work as it relates to tobacco and nicotine products.

Phone

Submit

Hannah Brown2022-08-30T09:32:05-04:00