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Registration Agreement

Please complete the form below. Upon completion you will be taken to our payment page for you to complete registration payment. This form alone does not register you for the event. You must complete payment after submitting this form.

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Primal Planitz™ - Primal Diet™ Conference

produced by Primal Planitz, a Virginia Business Trust

PARTICIPANT RELEASE FORM

NOTE: THIS IS AN IMPORTANT LEGAL DOCUMENT THAT MAY AFFECT YOUR LEGAL RIGHTS. PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN AT THE BOTTOM ONLY IF YOU AGREE:

Email(Required)

How many participants are you registering?(Required)

Participant #1

I realize that the Primal Diet ™ is a powerful tool for achieving optimal health. Primal Planitz™, and Primal Planitz, a Virginia Business trust are only making suggestions that reflect the opinions of Aajonus Vonderplanitz. We are not doctors or nutritionists. None of the information you are going to receive during this conference is intended to diagnose, treat, or cure disease. We are merely reflecting Aajonus’ research to you and acknowledging what has worked for him and us. Each human body is different and only you are capable of making decisions about your diet and health. Please consult a physician or licensed practitioner for medical advice.(Required)

Please initial in the text box below:

I realize that RAW FOODS and all foods that are served at the Primal Planitz™- Primal Diet™ Conference have a powerful positive impact on our health by including enzymes and bacteria. I realize that the best way to receive all the benefits of the macronutrients, vitamins, and minerals is by eating live foods. I also realize that eating raw foods containing healthy bacteria and enzymes that contribute to better digestion and assimilation of nutrients and do not create acrylomides, heterocycclic amines, lipid peroxides or advanced glycation end products which contribute to disease. I accept FULL responsibility for eating these life giving foods. I understand that I may get gravely ill consuming raw and uncooked foods and may have a reaction (ie nausea, fever, rash, headache, diarrhea, runny nose, etc.) This may be for reasons including a result of detoxification which is the healthy process of our body excreting dead cells, chemicals and toxins. I take full responsibility for my choice to eat these life-giving foods and release Primal Planitz, a Virginia Business Trust , Primal Planitz™as the organizers, assistants and staff, Simply Grassfed, Burke’s Garden Farm, Healthfully Farm, Tatara Ridge, Miller’s Organic Farm, from any and all liability.(Required)

Please initial in the text box below:

Any dairy that I consume comes from my own cow. Registering for the Priaml Planitz™ - Primal Diet™ Conference, confirms your agreement to participate in our Herdshare Program, which entitles you to a share of dairy from your own cow. You are paying for us to board and milk your cow. I take full responsibility for any accident or injury I incur at the Primal Planitz™ - Primal Diet™ Conference(Required)

Please initial in the text box below:

I have fully disclosed my physical, emotional, and mental background to the staff of the Primal Planitz™ - Primal Diet™ Conference. I realize that all staff, assistants, coaches, volunteers and/or agents are here only as a guides to my processes and none of the staff, assistants, coaches, presenters, volunteers and/or agents are here to replace any form of traditional mental or physical health treatment or spiritual modalities. I have talked with any and all mental and physical health care professionals that I believe would be necessary to assess whether I would be an appropriate person to participate in the Primal Planitz™ - Primal Diet™ Conference, based upon my physical, emotional, and mental health history and current condition(s). I attest that there is no reason why I should not be able to participate.(Required)

Please initial in the text box below:

To this purpose, I voluntarily participate in the Primal Planitz™ - Primal Diet™ Conference and I release and hold harmless Primal Diet Coaching, Primal Planitz™, Primal Planitz, a Virginia Business Trust and all members of the staff individually and any assistants, volunteers, coaches, presenters, and/or agents as well as the Burke’s Garden Farm, Simply Grassfed, Healthfully Farm, Miller’s Organic Farm, and Tatara Ridge, for any and all acts or omissions which may be grounds for legal action, including but not limited to acts or omissions which may constitute ordinary negligence. This release is intended to apply to all acts or omissions whether they be related to the grounds, premises, staff, assistants, volunteers and/or agents. I accept full responsibility for my own physical, mental, emotional and spiritual well-being. I know of no physical or mental health reason why I should not participate in this conference and I have fully explored this issue with Primal Diet Coaching staff as well as any other medical and/or legal advisors I deem appropriate. I have asked all the questions I may have and have received answers adequate so that I freely and knowingly waive all liability as set forth above without reservation of any kind. I further attest and acknowledge that this release is intended and shall apply to my heirs, beneficiaries and assigns. I acknowledge that I have been given the opportunity to seek independent legal advice before signing this agreement. This acknowledgment confirms that you were informed of the importance of obtaining legal counsel, understood the terms of the agreement, and voluntarily chose to proceed without such advice—or that you have obtained it.(Required)

Please initial in the text box below:

Printed Name of Participant(Required)

Printed Name of Legal Guardian if Participant Under 18

Signature of Participant or Legal Guardian if Participant is Under 18(Required)

Date(Required)

Participant #2

I realize that the Primal Diet ™ is a powerful tool for achieving optimal health. Primal Planitz™, and Primal Planitz, a Virginia Business trust are only making suggestions that reflect the opinions of Aajonus Vonderplanitz. We are not doctors or nutritionists. None of the information you are going to receive during this conference is intended to diagnose, treat, or cure disease. We are merely reflecting Aajonus’ research to you and acknowledging what has worked for him and us. Each human body is different and only you are capable of making decisions about your diet and health. Please consult a physician or licensed practitioner for medical advice.(Required)

Please initial in the text box below:

I realize that RAW FOODS and all foods that are served at the Primal Planitz™- Primal Diet™ Conference have a powerful positive impact on our health by including enzymes and bacteria. I realize that the best way to receive all the benefits of the macronutrients, vitamins, and minerals is by eating live foods. I also realize that eating raw foods containing healthy bacteria and enzymes that contribute to better digestion and assimilation of nutrients and do not create acrylomides, heterocycclic amines, lipid peroxides or advanced glycation end products which contribute to disease. I accept FULL responsibility for eating these life giving foods. I understand that I may get gravely ill consuming raw and uncooked foods and may have a reaction (ie nausea, fever, rash, headache, diarrhea, runny nose, etc.) This may be for reasons including a result of detoxification which is the healthy process of our body excreting dead cells, chemicals and toxins. I take full responsibility for my choice to eat these life-giving foods and release Primal Planitz, a Virginia Business Trust , Primal Planitz™as the organizers, assistants and staff, Simply Grassfed, Burke’s Garden Farm, Healthfully Farm, Tatara Ridge, Miller’s Organic Farm, from any and all liability.(Required)

Please initial in the text box below:

Any dairy that I consume comes from my own cow. Registering for the Priaml Planitz™ - Primal Diet™ Conference, confirms your agreement to participate in our Herdshare Program, which entitles you to a share of dairy from your own cow. You are paying for us to board and milk your cow. I take full responsibility for any accident or injury I incur at the Primal Planitz™ - Primal Diet™ Conference(Required)

Please initial in the text box below:

I have fully disclosed my physical, emotional, and mental background to the staff of the Primal Planitz™ - Primal Diet™ Conference. I realize that all staff, assistants, coaches, volunteers and/or agents are here only as a guides to my processes and none of the staff, assistants, coaches, presenters, volunteers and/or agents are here to replace any form of traditional mental or physical health treatment or spiritual modalities. I have talked with any and all mental and physical health care professionals that I believe would be necessary to assess whether I would be an appropriate person to participate in the Primal Planitz™ - Primal Diet™ Conference, based upon my physical, emotional, and mental health history and current condition(s). I attest that there is no reason why I should not be able to participate.(Required)

Please initial in the text box below:

To this purpose, I voluntarily participate in the Primal Planitz™ - Primal Diet™ Conference and I release and hold harmless Primal Diet Coaching, Primal Planitz™, Primal Planitz, a Virginia Business Trust and all members of the staff individually and any assistants, volunteers, coaches, presenters, and/or agents as well as the Burke’s Garden Farm, Simply Grassfed, Healthfully Farm, Miller’s Organic Farm, and Tatara Ridge, for any and all acts or omissions which may be grounds for legal action, including but not limited to acts or omissions which may constitute ordinary negligence. This release is intended to apply to all acts or omissions whether they be related to the grounds, premises, staff, assistants, volunteers and/or agents. I accept full responsibility for my own physical, mental, emotional and spiritual well-being. I know of no physical or mental health reason why I should not participate in this conference and I have fully explored this issue with Primal Diet Coaching staff as well as any other medical and/or legal advisors I deem appropriate. I have asked all the questions I may have and have received answers adequate so that I freely and knowingly waive all liability as set forth above without reservation of any kind. I further attest and acknowledge that this release is intended and shall apply to my heirs, beneficiaries and assigns. I acknowledge that I have been given the opportunity to seek independent legal advice before signing this agreement. This acknowledgment confirms that you were informed of the importance of obtaining legal counsel, understood the terms of the agreement, and voluntarily chose to proceed without such advice—or that you have obtained it.(Required)

Please initial in the text box below:

Printed Name of Participant(Required)

Printed Name of Legal Guardian if Participant Under 18

Signature of Participant or Legal Guardian if Participant is Under 18(Required)

Date(Required)

Participant #3

I realize that the Primal Diet ™ is a powerful tool for achieving optimal health. Primal Planitz™, and Primal Planitz, a Virginia Business trust are only making suggestions that reflect the opinions of Aajonus Vonderplanitz. We are not doctors or nutritionists. None of the information you are going to receive during this conference is intended to diagnose, treat, or cure disease. We are merely reflecting Aajonus’ research to you and acknowledging what has worked for him and us. Each human body is different and only you are capable of making decisions about your diet and health. Please consult a physician or licensed practitioner for medical advice.(Required)

Please initial in the text box below:

I realize that RAW FOODS and all foods that are served at the Primal Planitz™- Primal Diet™ Conference have a powerful positive impact on our health by including enzymes and bacteria. I realize that the best way to receive all the benefits of the macronutrients, vitamins, and minerals is by eating live foods. I also realize that eating raw foods containing healthy bacteria and enzymes that contribute to better digestion and assimilation of nutrients and do not create acrylomides, heterocycclic amines, lipid peroxides or advanced glycation end products which contribute to disease. I accept FULL responsibility for eating these life giving foods. I understand that I may get gravely ill consuming raw and uncooked foods and may have a reaction (ie nausea, fever, rash, headache, diarrhea, runny nose, etc.) This may be for reasons including a result of detoxification which is the healthy process of our body excreting dead cells, chemicals and toxins. I take full responsibility for my choice to eat these life-giving foods and release Primal Planitz, a Virginia Business Trust , Primal Planitz™as the organizers, assistants and staff, Simply Grassfed, Burke’s Garden Farm, Healthfully Farm, Tatara Ridge, Miller’s Organic Farm, from any and all liability.(Required)

Please initial in the text box below:

Any dairy that I consume comes from my own cow. Registering for the Priaml Planitz™ - Primal Diet™ Conference, confirms your agreement to participate in our Herdshare Program, which entitles you to a share of dairy from your own cow. You are paying for us to board and milk your cow. I take full responsibility for any accident or injury I incur at the Primal Planitz™ - Primal Diet™ Conference(Required)

Please initial in the text box below:

I have fully disclosed my physical, emotional, and mental background to the staff of the Primal Planitz™ - Primal Diet™ Conference. I realize that all staff, assistants, coaches, volunteers and/or agents are here only as a guides to my processes and none of the staff, assistants, coaches, presenters, volunteers and/or agents are here to replace any form of traditional mental or physical health treatment or spiritual modalities. I have talked with any and all mental and physical health care professionals that I believe would be necessary to assess whether I would be an appropriate person to participate in the Primal Planitz™ - Primal Diet™ Conference, based upon my physical, emotional, and mental health history and current condition(s). I attest that there is no reason why I should not be able to participate.(Required)

Please initial in the text box below:

To this purpose, I voluntarily participate in the Primal Planitz™ - Primal Diet™ Conference and I release and hold harmless Primal Diet Coaching, Primal Planitz™, Primal Planitz, a Virginia Business Trust and all members of the staff individually and any assistants, volunteers, coaches, presenters, and/or agents as well as the Burke’s Garden Farm, Simply Grassfed, Healthfully Farm, Miller’s Organic Farm, and Tatara Ridge, for any and all acts or omissions which may be grounds for legal action, including but not limited to acts or omissions which may constitute ordinary negligence. This release is intended to apply to all acts or omissions whether they be related to the grounds, premises, staff, assistants, volunteers and/or agents. I accept full responsibility for my own physical, mental, emotional and spiritual well-being. I know of no physical or mental health reason why I should not participate in this conference and I have fully explored this issue with Primal Diet Coaching staff as well as any other medical and/or legal advisors I deem appropriate. I have asked all the questions I may have and have received answers adequate so that I freely and knowingly waive all liability as set forth above without reservation of any kind. I further attest and acknowledge that this release is intended and shall apply to my heirs, beneficiaries and assigns. I acknowledge that I have been given the opportunity to seek independent legal advice before signing this agreement. This acknowledgment confirms that you were informed of the importance of obtaining legal counsel, understood the terms of the agreement, and voluntarily chose to proceed without such advice—or that you have obtained it.(Required)

Please initial in the text box below:

Printed Name of Participant(Required)

Printed Name of Legal Guardian if Participant Under 18

Signature of Participant or Legal Guardian if Participant is Under 18(Required)

Date(Required)

Participant #4

I realize that the Primal Diet ™ is a powerful tool for achieving optimal health. Primal Planitz™, and Primal Planitz, a Virginia Business trust are only making suggestions that reflect the opinions of Aajonus Vonderplanitz. We are not doctors or nutritionists. None of the information you are going to receive during this conference is intended to diagnose, treat, or cure disease. We are merely reflecting Aajonus’ research to you and acknowledging what has worked for him and us. Each human body is different and only you are capable of making decisions about your diet and health. Please consult a physician or licensed practitioner for medical advice.(Required)

Please initial in the text box below:

I realize that RAW FOODS and all foods that are served at the Primal Planitz™- Primal Diet™ Conference have a powerful positive impact on our health by including enzymes and bacteria. I realize that the best way to receive all the benefits of the macronutrients, vitamins, and minerals is by eating live foods. I also realize that eating raw foods containing healthy bacteria and enzymes that contribute to better digestion and assimilation of nutrients and do not create acrylomides, heterocycclic amines, lipid peroxides or advanced glycation end products which contribute to disease. I accept FULL responsibility for eating these life giving foods. I understand that I may get gravely ill consuming raw and uncooked foods and may have a reaction (ie nausea, fever, rash, headache, diarrhea, runny nose, etc.) This may be for reasons including a result of detoxification which is the healthy process of our body excreting dead cells, chemicals and toxins. I take full responsibility for my choice to eat these life-giving foods and release Primal Planitz, a Virginia Business Trust , Primal Planitz™as the organizers, assistants and staff, Simply Grassfed, Burke’s Garden Farm, Healthfully Farm, Tatara Ridge, Miller’s Organic Farm, from any and all liability.(Required)

Please initial in the text box below:

Any dairy that I consume comes from my own cow. Registering for the Priaml Planitz™ - Primal Diet™ Conference, confirms your agreement to participate in our Herdshare Program, which entitles you to a share of dairy from your own cow. You are paying for us to board and milk your cow. I take full responsibility for any accident or injury I incur at the Primal Planitz™ - Primal Diet™ Conference(Required)

Please initial in the text box below:

I have fully disclosed my physical, emotional, and mental background to the staff of the Primal Planitz™ - Primal Diet™ Conference. I realize that all staff, assistants, coaches, volunteers and/or agents are here only as a guides to my processes and none of the staff, assistants, coaches, presenters, volunteers and/or agents are here to replace any form of traditional mental or physical health treatment or spiritual modalities. I have talked with any and all mental and physical health care professionals that I believe would be necessary to assess whether I would be an appropriate person to participate in the Primal Planitz™ - Primal Diet™ Conference, based upon my physical, emotional, and mental health history and current condition(s). I attest that there is no reason why I should not be able to participate.(Required)

Please initial in the text box below:

To this purpose, I voluntarily participate in the Primal Planitz™ - Primal Diet™ Conference and I release and hold harmless Primal Diet Coaching, Primal Planitz™, Primal Planitz, a Virginia Business Trust and all members of the staff individually and any assistants, volunteers, coaches, presenters, and/or agents as well as the Burke’s Garden Farm, Simply Grassfed, Healthfully Farm, Miller’s Organic Farm, and Tatara Ridge, for any and all acts or omissions which may be grounds for legal action, including but not limited to acts or omissions which may constitute ordinary negligence. This release is intended to apply to all acts or omissions whether they be related to the grounds, premises, staff, assistants, volunteers and/or agents. I accept full responsibility for my own physical, mental, emotional and spiritual well-being. I know of no physical or mental health reason why I should not participate in this conference and I have fully explored this issue with Primal Diet Coaching staff as well as any other medical and/or legal advisors I deem appropriate. I have asked all the questions I may have and have received answers adequate so that I freely and knowingly waive all liability as set forth above without reservation of any kind. I further attest and acknowledge that this release is intended and shall apply to my heirs, beneficiaries and assigns. I acknowledge that I have been given the opportunity to seek independent legal advice before signing this agreement. This acknowledgment confirms that you were informed of the importance of obtaining legal counsel, understood the terms of the agreement, and voluntarily chose to proceed without such advice—or that you have obtained it.(Required)

Please initial in the text box below:

Printed Name of Participant(Required)

Printed Name of Legal Guardian if Participant Under 18

Signature of Participant or Legal Guardian if Participant is Under 18(Required)

Date(Required)

Participant #5

I realize that the Primal Diet ™ is a powerful tool for achieving optimal health. Primal Planitz™, and Primal Planitz, a Virginia Business trust are only making suggestions that reflect the opinions of Aajonus Vonderplanitz. We are not doctors or nutritionists. None of the information you are going to receive during this conference is intended to diagnose, treat, or cure disease. We are merely reflecting Aajonus’ research to you and acknowledging what has worked for him and us. Each human body is different and only you are capable of making decisions about your diet and health. Please consult a physician or licensed practitioner for medical advice.(Required)

Please initial in the text box below:

I realize that RAW FOODS and all foods that are served at the Primal Planitz™- Primal Diet™ Conference have a powerful positive impact on our health by including enzymes and bacteria. I realize that the best way to receive all the benefits of the macronutrients, vitamins, and minerals is by eating live foods. I also realize that eating raw foods containing healthy bacteria and enzymes that contribute to better digestion and assimilation of nutrients and do not create acrylomides, heterocycclic amines, lipid peroxides or advanced glycation end products which contribute to disease. I accept FULL responsibility for eating these life giving foods. I understand that I may get gravely ill consuming raw and uncooked foods and may have a reaction (ie nausea, fever, rash, headache, diarrhea, runny nose, etc.) This may be for reasons including a result of detoxification which is the healthy process of our body excreting dead cells, chemicals and toxins. I take full responsibility for my choice to eat these life-giving foods and release Primal Planitz, a Virginia Business Trust , Primal Planitz™as the organizers, assistants and staff, Simply Grassfed, Burke’s Garden Farm, Healthfully Farm, Tatara Ridge, Miller’s Organic Farm, from any and all liability.(Required)

Please initial in the text box below:

Any dairy that I consume comes from my own cow. Registering for the Priaml Planitz™ - Primal Diet™ Conference, confirms your agreement to participate in our Herdshare Program, which entitles you to a share of dairy from your own cow. You are paying for us to board and milk your cow. I take full responsibility for any accident or injury I incur at the Primal Planitz™ - Primal Diet™ Conference(Required)

Please initial in the text box below:

I have fully disclosed my physical, emotional, and mental background to the staff of the Primal Planitz™ - Primal Diet™ Conference. I realize that all staff, assistants, coaches, volunteers and/or agents are here only as a guides to my processes and none of the staff, assistants, coaches, presenters, volunteers and/or agents are here to replace any form of traditional mental or physical health treatment or spiritual modalities. I have talked with any and all mental and physical health care professionals that I believe would be necessary to assess whether I would be an appropriate person to participate in the Primal Planitz™ - Primal Diet™ Conference, based upon my physical, emotional, and mental health history and current condition(s). I attest that there is no reason why I should not be able to participate.(Required)

Please initial in the text box below:

To this purpose, I voluntarily participate in the Primal Planitz™ - Primal Diet™ Conference and I release and hold harmless Primal Diet Coaching, Primal Planitz™, Primal Planitz, a Virginia Business Trust and all members of the staff individually and any assistants, volunteers, coaches, presenters, and/or agents as well as the Burke’s Garden Farm, Simply Grassfed, Healthfully Farm, Miller’s Organic Farm, and Tatara Ridge, for any and all acts or omissions which may be grounds for legal action, including but not limited to acts or omissions which may constitute ordinary negligence. This release is intended to apply to all acts or omissions whether they be related to the grounds, premises, staff, assistants, volunteers and/or agents. I accept full responsibility for my own physical, mental, emotional and spiritual well-being. I know of no physical or mental health reason why I should not participate in this conference and I have fully explored this issue with Primal Diet Coaching staff as well as any other medical and/or legal advisors I deem appropriate. I have asked all the questions I may have and have received answers adequate so that I freely and knowingly waive all liability as set forth above without reservation of any kind. I further attest and acknowledge that this release is intended and shall apply to my heirs, beneficiaries and assigns. I acknowledge that I have been given the opportunity to seek independent legal advice before signing this agreement. This acknowledgment confirms that you were informed of the importance of obtaining legal counsel, understood the terms of the agreement, and voluntarily chose to proceed without such advice—or that you have obtained it.(Required)

Please initial in the text box below:

Printed Name of Participant(Required)

Printed Name of Legal Guardian if Participant Under 18

Signature of Participant or Legal Guardian if Participant is Under 18(Required)

Date(Required)

Participant #6

I realize that the Primal Diet ™ is a powerful tool for achieving optimal health. Primal Planitz™, and Primal Planitz, a Virginia Business trust are only making suggestions that reflect the opinions of Aajonus Vonderplanitz. We are not doctors or nutritionists. None of the information you are going to receive during this conference is intended to diagnose, treat, or cure disease. We are merely reflecting Aajonus’ research to you and acknowledging what has worked for him and us. Each human body is different and only you are capable of making decisions about your diet and health. Please consult a physician or licensed practitioner for medical advice.(Required)

Please initial in the text box below:

I realize that RAW FOODS and all foods that are served at the Primal Planitz™- Primal Diet™ Conference have a powerful positive impact on our health by including enzymes and bacteria. I realize that the best way to receive all the benefits of the macronutrients, vitamins, and minerals is by eating live foods. I also realize that eating raw foods containing healthy bacteria and enzymes that contribute to better digestion and assimilation of nutrients and do not create acrylomides, heterocycclic amines, lipid peroxides or advanced glycation end products which contribute to disease. I accept FULL responsibility for eating these life giving foods. I understand that I may get gravely ill consuming raw and uncooked foods and may have a reaction (ie nausea, fever, rash, headache, diarrhea, runny nose, etc.) This may be for reasons including a result of detoxification which is the healthy process of our body excreting dead cells, chemicals and toxins. I take full responsibility for my choice to eat these life-giving foods and release Primal Planitz, a Virginia Business Trust , Primal Planitz™as the organizers, assistants and staff, Simply Grassfed, Burke’s Garden Farm, Healthfully Farm, Tatara Ridge, Miller’s Organic Farm, from any and all liability.(Required)

Please initial in the text box below:

Any dairy that I consume comes from my own cow. Registering for the Priaml Planitz™ - Primal Diet™ Conference, confirms your agreement to participate in our Herdshare Program, which entitles you to a share of dairy from your own cow. You are paying for us to board and milk your cow. I take full responsibility for any accident or injury I incur at the Primal Planitz™ - Primal Diet™ Conference(Required)

Please initial in the text box below:

I have fully disclosed my physical, emotional, and mental background to the staff of the Primal Planitz™ - Primal Diet™ Conference. I realize that all staff, assistants, coaches, volunteers and/or agents are here only as a guides to my processes and none of the staff, assistants, coaches, presenters, volunteers and/or agents are here to replace any form of traditional mental or physical health treatment or spiritual modalities. I have talked with any and all mental and physical health care professionals that I believe would be necessary to assess whether I would be an appropriate person to participate in the Primal Planitz™ - Primal Diet™ Conference, based upon my physical, emotional, and mental health history and current condition(s). I attest that there is no reason why I should not be able to participate.(Required)

Please initial in the text box below:

To this purpose, I voluntarily participate in the Primal Planitz™ - Primal Diet™ Conference and I release and hold harmless Primal Diet Coaching, Primal Planitz™, Primal Planitz, a Virginia Business Trust and all members of the staff individually and any assistants, volunteers, coaches, presenters, and/or agents as well as the Burke’s Garden Farm, Simply Grassfed, Healthfully Farm, Miller’s Organic Farm, and Tatara Ridge, for any and all acts or omissions which may be grounds for legal action, including but not limited to acts or omissions which may constitute ordinary negligence. This release is intended to apply to all acts or omissions whether they be related to the grounds, premises, staff, assistants, volunteers and/or agents. I accept full responsibility for my own physical, mental, emotional and spiritual well-being. I know of no physical or mental health reason why I should not participate in this conference and I have fully explored this issue with Primal Diet Coaching staff as well as any other medical and/or legal advisors I deem appropriate. I have asked all the questions I may have and have received answers adequate so that I freely and knowingly waive all liability as set forth above without reservation of any kind. I further attest and acknowledge that this release is intended and shall apply to my heirs, beneficiaries and assigns. I acknowledge that I have been given the opportunity to seek independent legal advice before signing this agreement. This acknowledgment confirms that you were informed of the importance of obtaining legal counsel, understood the terms of the agreement, and voluntarily chose to proceed without such advice—or that you have obtained it.(Required)

Please initial in the text box below:

Printed Name of Participant(Required)

Printed Name of Legal Guardian if Participant Under 18

Signature of Participant or Legal Guardian if Participant is Under 18(Required)

Date(Required)

After clicking "Submit", you will be taken to our payment check out page. Select the conference program options, products, and services for you and make your payment. You must complete payment after submitting this form to be registered for the conference. You will receive an email from us confirming your registration after your form and payment are received. Thank you.