Date: Participant Signature: Signature of Parent

or Guardian (if under 18):

HAVING READ THE ABOVE TERMS AND INTENDING TO BE LEGALLY BOUND HEREBY AND UNDERSTANDING THIS DOCUMENT TO BE A COMPLETE WAIVER AND RELEASE IN FAVOR OF THE NUTRITION COACH, NUTRITION CLUB, FITCLUB AND HERBALIFE OF ANY AND ALL LIABILITY, I HEREBY AFFIX MY SIGNATURE HERETO.

Participant Name: Address: City: Home Phone:

State: Zip: Work:

THE FOLLOWING IS A RELEASE AND WAIVER. READ IT BEFORE