RELEASE FORM

I do hereby grant Accu Weight-Loss System, Inc., AccuQuest Health Programs, Inc., and their respective affiliates, agents and assigns (collectively, “Grantee”) an irrevocable, unrestricted, royalty-free right and license to use, reproduce, display, adapt, modify and/or distribute, my name and likeness, including, without limitation “before” and “after” photographs, and any testimonials provided by me with respect to Acc(u)Life® Accu Weight-Loss® “The Bead Diet”® or any other program or service provided by Grantee, in all forms and media (including but not limited to print, TV, radio, websites, email, social media) and in all manners, for Grantee’s marketing, advertising, publicity and promotional efforts and all other lawful purposes.

I waive any right to inspect or approve the finished versions, including written copy that may be created in connection therewith. I understand that I will not be paid at any time for the use of any images, information or other media provided by me, and no representation to the contrary has been made to me.