Submission of Success Story : Certification and Release

I hereby certify that I am over the age of 18 years.

I hereby certify that I have achieved weight loss by using Nutribar, in accordance with the directions on the packaging.

I hereby certify that I have lost weight without the use of weight reducing procedures or surgery.

I certify that I have lost this weight without drastic changes to my diet and / or exercise.

I hereby consent to the use of my photographs, the recording of my voice, and the use of these photographs and / or recordings, singularly in conjunction with other photographs and / or recording for advertising, publicity, commercial or other business purposes. I understand the term, “photograph” as used herein encompasses both still photographs and motion picture / video footage.

I further consent to the use of any information provided by me in the form of testimonials, endorsements or other form to be used for advertising, publicity, commercial, or other business purposes.

I hereby waive the right to review and approve any finished product or demand monetary compensation for the use of any information, and understand that all materials will become the property of Nutribar and will not be returned.

I further consent to the reproduction and / or authorization by Nutribar to reproduce and use said photographs and / or recordings of my voice, for use in all domestic and foreign markets. Further, I understand that others with or without the consent of Nutribar may use and / or reproduce such photographs and recordings.

I hereby release Nutribar and any of its associated and affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees and assignees from all claims of every kind on account of such use.

Nutribar maintains the security and integrity of your personal information in compliance with all applicable laws and in accordance with our privacy policy.