I ,

with (valid) email address ,

of , dated ,

 hereby enter into this contract with myself, and declare that the following is true and correct:

Whereas I have already quit smoking,      (When did you quit? )

Whereas I am currently not smoking,

Whereas I have gone through the BIG QUIT and I have quit smoking in a memorable and positive way,
(What did you do for the Big Quit? )

Whereas I have made a list of the top 5 situations that are likely to cause an urge to smoke,

Whereas I have thrown away all my ashtrays, (even the fancy, expensive ones),

Whereas I have thrown away all my cigarettes in a place where I can't possibly get them back,
(What did you do with your last cigarettes? )

Whereas I understand that in order to successfully quit smoking, I know I need to quit smoking for the rest of my life,

Whereas I know that quitting smoking takes a huge amount of COURAGE and I have the courage to Never Smoke Again,

Whereas I choose to be a non-smoker,

Whereas I know that if I don't quit smoking it will make me sick and might kill me,

Whereas I am going to fill out the NeverSmokeAgain.Com survey on the final page of this website (a little pushy, but would you mind?)

Indicate any personal affirmations about your reasons and feelings about quitting smoking here:
 

I do hereby agree that for the REST OF MY LIFE I will NEVER SMOKE cigarettes or any other type of tobacco AGAIN. I will never put a lit cigarette in my mouth for the rest of my life. For as long as I live, I do solemnly, sincerely, and truly declare that I will never, ever, ever smoke another cigarette again. Never!

I will Never Smoke Again for the rest of my life!

(Print out a copy of this contract before you press the button below and sign and date it.)

 

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Signature                                       date