Maynestreet Balancing Program Maynestreet Balancing Application Step 1 of 3 33% Your Personal InformationYour Name First Last Your Email Address Enter Email Confirm Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Cell PhoneReferred byPlease put the name of the person who referred you or the referral code given to you. Starting InformationBirth Date MM slash DD slash YYYY Height Biological GenderFemaleMaleOccupation Current Weight Goal Weight Living situationWe want to understand your basic living situation. Do you take medications for high blood pressure?(Required)The program has a swift impact on balancing and regulating blood pressure and over-medicating is a safety concern. Yes No Medications that I am currently prescribedFoods that I have sensitives or allergies to. More About YouTell Us About YourselfHealth QualificationAre you pregnant or breastfeeding now? Do you have internal cancer, a blood disorder, systemic lupus, kidney disease, liver disease, chronic heart disease (such as congestive heart failure or rheumatic fever), or anorexia/bulimia? Are you currently receiving radiation or chemotherapy? Yes No Terms and Conditions(Required)This Agreement is entered into by and between Maynestreet Weight Loss LLC. and the Client. Maynestreet Weight Loss LLC and the Client agree to enter the Maynestreet Weight Loss Program and professional relationship specified in this document. MAYNESTREET WEIGHT LOSS LLC-CLIENT RELATIONSHIP A. Maynestreet Weight Loss LLC acknowledges that the Client is the expert in navigating their own life, based on personal preferences and experiences. B. The Client is solely responsible for decisions, actions, choices, lifestyle changes, and results throughout the Maynestreet Weight Loss Program (the Program). C. The Client acknowledges that the Maynestreet Weight Loss LLC acts as a facilitative partner and that the Maynestreet Weight Loss LLC’s primary role is not that of a content expert or educator or to diagnose, advise, or instruct the Client on what to do. D. The Client agrees to communicate honestly and dedicate their time and energy to participating fully in the Program. E. The Client understands that their results are closely tied to adherence to the Program. STAGE 1 – Balancing The parties agree to engage in the Program, which includes the following: A. Maynestreet balancing program will last approximately 30 days. B. Clients have a choice to watch the “On-boarding” video or request virtual meeting to go over the program. C. The client will text their daily progress and questions to their assigned Maynestreet Facilitator. D. Clients are encouraged to attend the monthly “Live on Maynestreet” national community meeting – Via Zoom The Program begins on the agreed start date and ends on the 30th day following the start date Individual Program Fees The full Maynestreet Program – $899.00 A REFUND IS NOT AVAILABLE FOR EARLY TERMINATION OF THE PROGRAM. Maynestreet Weight Loss LLC. reserves the right to cancel the Program if at any point the Maynestreet Mentor feels it’s not advantageous for the Program to continue. If this happens, the Client is only responsible for the pro rata share of Maynestreet services received. DISCLAIMERS The Client understands that the role of the Maynestreet is solely for weight loss, not to prescribe or assess specific meal plans; provide healthcare, medical, or nutrition therapy services; or diagnose, treat, or cure any disease, condition, or other physical or mental ailment of the human body. Rather, the Mentor has been trained on the Maynestreet program and is there to help clients reach their own health goals by helping clients devise and implement positive, sustainable lifestyle changes. The Client understands that the Mentor is not acting in the capacity of a doctor, dietitian, nutritionist, psychologist, psychotherapist, or other licensed or registered professional, and that the Program is not intended to replace services performed by these professionals. The Client acknowledges that, if under the care of healthcare professionals, the Client should discuss any dietary changes or potential dietary supplement use with those professionals. If the Client currently uses prescription medications, the Client should not discontinue any prescription medications without first consulting the Client’s prescribing healthcare provider. The Client has chosen to work with the Maynestreet Mentor and understands that Maynestreet Mentoring services, including any information or resources received, are not medical advice nor meant to replace services delivered by licensed health professionals. PERSONAL RESPONSIBILITY AND RELEASE OF HEALTHCARE-RELATED CLAIMS The Client acknowledges that the Client takes full responsibility for the Client’s life and well-being, as well as the lives and well-being of the Client’s family and children (where applicable), and all decisions made during and after the Program. The Client expressly assumes the risks of the Program, including the risks inherent in making dietary and/or lifestyle changes. The Client releases the Maynestreet Mentor from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which the Client ever had, now has, or will have in the future against the Maynestreet Mentor and Maynestreet Weight Loss LLC, arising from the Client’s past or future participation in, or otherwise with respect to, the Program. CONFIDENTIALITY The Maynestreet Weight Loss LLC will keep the Client’s information private and will not share the Client’s information with any third party without the Client’s written consent unless required by law. The Maynestreet Mentor will not disclose the Client’s name as a reference or for use in any marketing materials without the Client’s written consent. All data, pictures, information, emails collected by Maynestreet Weight Loss LLC and its Mentors and staff are the sole property of Maynestreet Weight Loss LLC. ARBITRATION, CHOICE OF LAW, AND LIMITED REMEDIES In the event that there ever arises a dispute between the Maynestreet Weight Loss LLC and the Client with respect to the services provided pursuant to this Agreement or otherwise pertaining to the relationship between the parties, the parties agree to submit to binding arbitration before the American Arbitration Association (Commercial Arbitration and Mediation Center for the Americas Mediation and Arbitration Rules). Any judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Such arbitration shall be conducted by a single arbitrator. The sole remedy that can be awarded to the Client in the event that an award is granted in arbitration is a refund of the Program Fee. Without limiting the generality of the foregoing, no award of consequential or other damages, unless specifically set forth herein, may be granted to the Client. This Agreement shall be construed according to the laws of the State of Nevada. In the event that any provision of this Agreement is deemed unenforceable, the remaining portions of the Agreement shall be severed and remain in full force. If you agree to the terms of this agreement, please complete your transaction. By doing so, you acknowledge that you have read, understood, and accepted all of the terms of this agreement. I agree to the terms and conditions.Please type your full name as confirmation of terms.