Testimonial Release Form

I hereby grant SuperNutrition Life-Extension Research, Inc., its subsidiaries including SuperNutrition, its successors, officers, agents, and assigns, the right to use my name, photographs, the name and photographs of my child (if applicable), and any statements (or portion thereof) which I may make about the products used. I require no payment to make this testimonial; it is done voluntarily on my part. This release extends to any and all advertising, including television, as well as packaging.

E-mail addresses will not be shared or used for marketing purposes.