The Carlyle Appellate Law Firm

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Class Members have One Year from January 11, 2007, to file individual lawsuits for
compensatory and punitive damages based on binding findings from the Engle Trial.

Please fill out the information below to see if you or your loved one is eligible.

First Name		Email address
Last Name		Phone Number
Street Address		Work Number
Apartment/Suite		Mobile Number
City		Year(s) of Residence in Florida
State		Year began smoking
Zip		Brand(s) of cigarettes smoked

Best method and time(s) to contact you
Name of injured person (if other than yourself)
Relationship to injured person (if other than yourself)
Date of birth of injured person (mm-dd-yyyy)
Date of diagnosis of smoking-related disease
Date of death (if applicable)
Specify the smoking-related disease or illness Select all that apply (Press control and click for multiple diseases)

Please provide any other information that may help us understand your case

The Carlyle Building • 1950 Laurel Manor Drive • Suite 130 • The Villages, Florida 32162 • 866-2appeal (866.227.7325)