———— This Sweepstakes is only for Adult Tobacco Consumers ———— Electronic Signature Please enter your name and address as they appear on your driver's license or official ID: First Name * Last Name * Suffix -- Select -- SR JR I II III IV V   * I certify that I am a legal age tobacco consumer and that I want to receive products, offers, premiums, coupons and/or information from tobacco companies. I understand that giving false information in order to accept these offers may constitute a violation of law. Address * Apt/Lot # City * State * <--Select--> AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WY WV   Zip Code * Gender * --Select-- Male Female Birthday * --Month-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / --Day-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 E-Mail Address * Phone Number * - - * I would like to receive emails, including commercial emails, about special offers and/or other information from R. J. Reynolds Tobacco Company and its tobacco brands.

* Pursuant to the Electronic Signatures in Global and National Commerce Act and applicable state laws, I consent to R.J. Reynolds Tobacco Company's (and its affiliates) use and reliance on my electronic signature to verify the information that I have provided herein, and understand that I may withdraw this consent at any time by calling 1-800-665-6381. For more information about their information collection and use policies, please read their Privacy Statement. By submitting the registration information I certify that I have read and agreed to the Official Sweepstakes Rules and Sweepstakes Privacy Statement. I grant permission to verify my age. Subject to eligibility restrictions. Void where prohibited. No purchase necessary.